Provider Demographics
NPI:1740466010
Name:DOUG CHAMBERS DDS, PA
Entity type:Organization
Organization Name:DOUG CHAMBERS DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:316-634-1333
Mailing Address - Street 1:4620 E DOUGLAS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3955
Mailing Address - Country:US
Mailing Address - Phone:316-634-1333
Mailing Address - Fax:316-634-1253
Practice Address - Street 1:4620 E DOUGLAS AVE STE A
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3955
Practice Address - Country:US
Practice Address - Phone:316-634-1333
Practice Address - Fax:316-634-1253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5472122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty