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General NPI Number Information
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NPI Number | 1679147896
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Entity Type | Organization
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Legal Business Name | CHAMBERLAIN FAMILY ORTHODONTICS INC., A DENTAL PRACTICE
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Dates
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Enumeration Date | 05/13/2021
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Last Update Date | 05/13/2021
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Provider Practice Location Address
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Address Line | 232 CAJON ST STE D
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City | REDLANDS
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State | CA
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Zip | 92373-5216
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Country | US
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Telephone | 909-793-2791
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Fax | 909-793-9701
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Provider Business Mailing Address
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Address Line | 232 CAJON ST STE D
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City | REDLANDS
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State | CA
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Zip | 92373-5216
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Country | US
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Telephone | 909-793-2791
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ALEXANDRA MASCARO CHAMEBRLAIN-UMANOFF
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Credential | DDS, MS
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Telephone | 909-856-9748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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