Healthcare Provider Details

I. General information

NPI: 1053506311
Provider Name (Legal Business Name): ELIAS CHAMBERS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 WINDMILL PKWY
HENDERSON NV
89074-3385
US

IV. Provider business mailing address

2660 WINDMILL PKWY
HENDERSON NV
89074-3385
US

V. Phone/Fax

Practice location:
  • Phone: 702-990-2960
  • Fax: 702-990-2969
Mailing address:
  • Phone: 702-990-2960
  • Fax: 702-990-2969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5565
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: