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General NPI Number Information
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NPI Number | 1801060702
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Entity Type | Organization
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Legal Business Name | RANDALL W. CHAMBERS, DDS, PC
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 6143 28TH ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-6941
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Country | US
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Telephone | 616-949-4650
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Fax | 616-949-5377
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Provider Business Mailing Address
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Address Line | 6143 28TH ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-6941
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Country | US
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Telephone | 616-949-4650
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Fax | 616-949-5377
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANDALL WAYNE CHAMBERS II
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Credential | DDS
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Telephone | 616-949-4650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 17046
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License Number State | MI
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