Healthcare Provider Details

I. General information

NPI: 1740405620
Provider Name (Legal Business Name): DAVID M CHAMBERLAIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19657 STATE ROUTE 410 E
BONNEY LAKE WA
98391-5202
US

IV. Provider business mailing address

19657 STATE ROUTE 410 E
BONNEY LAKE WA
98391-5202
US

V. Phone/Fax

Practice location:
  • Phone: 253-780-7003
  • Fax: 253-780-7004
Mailing address:
  • Phone: 253-780-7003
  • Fax: 253-780-7004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number60904780
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: