Provider Demographics
NPI:1801060702
Name:RANDALL W. CHAMBERS, DDS, PC
Entity type:Organization
Organization Name:RANDALL W. CHAMBERS, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-949-4650
Mailing Address - Street 1:6143 28TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6941
Mailing Address - Country:US
Mailing Address - Phone:616-949-4650
Mailing Address - Fax:616-949-5377
Practice Address - Street 1:6143 28TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6941
Practice Address - Country:US
Practice Address - Phone:616-949-4650
Practice Address - Fax:616-949-5377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI17046261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1598772972OtherINDIVIDUAL NPI NUMBER