Provider Demographics
NPI:1023407327
Name:CHAMBERS, COLLEEN MARIE (DMD)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARIE
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:CT
Mailing Address - Zip Code:06424-1644
Mailing Address - Country:US
Mailing Address - Phone:860-810-8728
Mailing Address - Fax:
Practice Address - Street 1:1915 E MAIN ST
Practice Address - Street 2:APT #D317
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7155
Practice Address - Country:US
Practice Address - Phone:860-810-8728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-10
Last Update Date:2015-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0442000215122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist