Provider Demographics
NPI:1770572661
Name:CHAMBERS, RUSSELL GEORGE (DDS)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:GEORGE
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 1:207 KINGS CT
Mailing Address - Street 2:
Mailing Address - City:ALCOA
Mailing Address - State:TN
Mailing Address - Zip Code:37701-1939
Mailing Address - Country:US
Mailing Address - Phone:865-983-6361
Mailing Address - Fax:865-983-2179
Practice Address - Street 1:207 KINGS CT
Practice Address - Street 2:
Practice Address - City:ALCOA
Practice Address - State:TN
Practice Address - Zip Code:37701-1939
Practice Address - Country:US
Practice Address - Phone:865-983-6361
Practice Address - Fax:865-983-2179
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS34361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice