Provider Demographics
NPI:1932380482
Name:CHAMBERLAIN, LAURA LEA (DDS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LEA
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3608 SHANNON RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6344
Mailing Address - Country:US
Mailing Address - Phone:919-489-5600
Mailing Address - Fax:919-489-2555
Practice Address - Street 1:3608 SHANNON RD
Practice Address - Street 2:SUITE 205
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6344
Practice Address - Country:US
Practice Address - Phone:919-489-5600
Practice Address - Fax:919-489-2555
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC55461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
974731OtherUNITED CONCORDIA
NC91481OtherBCBS