MEDICARE: DR. CARLESHA JANEE CHAMBERS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30.023468	OH

General Provider Information

NPI Number	:	1124387667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLESHA JANEE CHAMBERS DDS

Provider Business Mailing Address
First Line	:	9275 DOERR RD STE 1400
Second Line	:	HQ, NORTHERN REGIONAL DENTAL COMMAND (ATTN CREDENTIALS)
City	:	FORT BELVOIR
State	:	VA
Zip	:	22060-2204
Country	:	US
Telephone Number	:	571-231-5383
Fax Number	:

Provider Business Practice Location Address
First Line	:	9275 DOERR RD STE 1400
Second Line	:	HQ, NORTHERN REGIONAL DENTAL COMMAND (ATTN CREDENTIALS)
City	:	FORT BELVOIR
State	:	VA
Zip	:	22060-2204
Country	:	US
Telephone Number	:	571-231-5383
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2012
Last Update Date	:	06/09/2014

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