Provider Demographics
NPI:1831181098
Name:CHAMBERLAIN, THADDEUS MILES (DDS)
Entity type:Individual
Prefix:DR
First Name:THADDEUS
Middle Name:MILES
Last Name:CHAMBERLAIN
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 1:21142 SANTA LUCIA
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-2173
Mailing Address - Country:US
Mailing Address - Phone:210-565-0647
Mailing Address - Fax:210-565-4240
Practice Address - Street 1:21142 SANTA LUCIA
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-2173
Practice Address - Country:US
Practice Address - Phone:210-565-0647
Practice Address - Fax:210-565-4240
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA075191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice