Provider Demographics
NPI:1205912219
Name:CHAMBERS, LARRY (DDS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 RIDGECREST DR.
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305
Mailing Address - Country:US
Mailing Address - Phone:731-668-8907
Mailing Address - Fax:
Practice Address - Street 1:3067 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3411
Practice Address - Country:US
Practice Address - Phone:731-668-7916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS4211122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN803388OtherUCCI
TN0149768OtherBCBS CORP ID#
TN0132345OtherBCBS/TN