Healthcare Provider Details

I. General information

NPI: 1912220724
Provider Name (Legal Business Name): JOAN ELAINE CHAMBERLAIN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6760 ABRAMS RD 201
DALLAS TX
75231-7177
US

IV. Provider business mailing address

6760 ABRAMS RD 201
DALLAS TX
75231-7177
US

V. Phone/Fax

Practice location:
  • Phone: 214-349-9455
  • Fax: 214-349-9464
Mailing address:
  • Phone: 214-349-9455
  • Fax: 214-349-9464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12893
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: