Healthcare Provider Details

I. General information

NPI: 1306943733
Provider Name (Legal Business Name): HARRY DONALD CHAMBERS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21825 SE STARK ST. SUITE A
GRESHAM OR
97030
US

IV. Provider business mailing address

21825 SE STARK ST. SUITE A
GRESHAM OR
97030
US

V. Phone/Fax

Practice location:
  • Phone: 503-665-9737
  • Fax: 503-666-7709
Mailing address:
  • Phone: 503-665-9737
  • Fax: 503-666-7709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5583
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: