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General NPI Number Information
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NPI Number | 1124097365
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Entity Type | Organization
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Legal Business Name | KEITH D. CHAMBERS, D.M.D.,P.S.C.
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Dates
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Enumeration Date | 03/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 401 BOGLE ST SUITE 204
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City | SOMERSET
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State | KY
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Zip | 42503-2850
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Country | US
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Telephone | 606-451-0888
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Fax | 606-451-0889
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Provider Business Mailing Address
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Address Line | 401 BOGLE ST SUITE 204
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City | SOMERSET
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State | KY
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Zip | 42503-2850
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Country | US
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Telephone | 606-451-0888
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Fax | 606-451-0889
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | KEITH CHAMBERS
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Credential | D.M.D.
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Telephone | 606-451-0888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 6660
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License Number State | KY
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