Provider Demographics
NPI:1770527707
Name:CHAMBLISS, RICHARD BAKER JR (DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BAKER
Last Name:CHAMBLISS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:3000 SOUTHLAKE PARK
Mailing Address - Street 2:STE. 200
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3293
Mailing Address - Country:US
Mailing Address - Phone:205-453-0314
Mailing Address - Fax:205-453-0315
Practice Address - Street 1:3000 SOUTHLAKE PARK
Practice Address - Street 2:STE. 200
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-3293
Practice Address - Country:US
Practice Address - Phone:205-453-0314
Practice Address - Fax:205-453-0315
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2013-02-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL51811223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009955005Medicaid