MEDICARE: BRIAN CHAMBERLAIN UNLIMITED PC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1366115453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIAN CHAMBERLAIN UNLIMITED PC

Provider Business Mailing Address
First Line	:	7090 N DURANGO DR STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4495
Country	:	US
Telephone Number	:	702-645-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	7090 N DURANGO DR STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4495
Country	:	US
Telephone Number	:	702-645-5100
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRIAN CHAMBERLAIN
Credential	:	DDS
Telephone Number	:	702-645-5100

Provider Enumeration Date	:	07/26/2021
Last Update Date	:	09/03/2021

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