Provider Demographics
NPI:1134205016
Name:CHAMBERLAIN, GLENN FRANKLIN (DDS, PA)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:FRANKLIN
Last Name:CHAMBERLAIN
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:FLIPPIN
Mailing Address - State:AR
Mailing Address - Zip Code:72634-0069
Mailing Address - Country:US
Mailing Address - Phone:870-453-8881
Mailing Address - Fax:
Practice Address - Street 1:808 MAIN ST.
Practice Address - Street 2:
Practice Address - City:FLIPPIN
Practice Address - State:AR
Practice Address - Zip Code:72634
Practice Address - Country:US
Practice Address - Phone:870-453-8881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR28041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice