Healthcare Provider Details

I. General information

NPI: 1124097365
Provider Name (Legal Business Name): KEITH D. CHAMBERS, D.M.D.,P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BOGLE ST SUITE 204
SOMERSET KY
42503-2850
US

IV. Provider business mailing address

401 BOGLE ST SUITE 204
SOMERSET KY
42503-2850
US

V. Phone/Fax

Practice location:
  • Phone: 606-451-0888
  • Fax: 606-451-0889
Mailing address:
  • Phone: 606-451-0888
  • Fax: 606-451-0889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6660
License Number StateKY

VIII. Authorized Official

Name: KEITH CHAMBERS
Title or Position: OWNER/PRESIDENT
Credential: D.M.D.
Phone: 606-451-0888