Provider Demographics
NPI:1447495502
Name:CHAMBERLAIN, JOSEPH R (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:R
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 1:1441 VETERAN AVE
Mailing Address - Street 2:#216
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4879
Mailing Address - Country:US
Mailing Address - Phone:310-619-5229
Mailing Address - Fax:
Practice Address - Street 1:1441 VETERAN AVE
Practice Address - Street 2:#216
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4879
Practice Address - Country:US
Practice Address - Phone:310-619-5229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57924122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist