Provider Demographics
NPI:1366115453
Name:BRIAN CHAMBERLAIN UNLIMITED PC
Entity type:Organization
Organization Name:BRIAN CHAMBERLAIN UNLIMITED PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBERLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-645-5100
Mailing Address - Street 1:7090 N DURANGO DR STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4495
Mailing Address - Country:US
Mailing Address - Phone:702-645-5100
Mailing Address - Fax:
Practice Address - Street 1:7090 N DURANGO DR STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4495
Practice Address - Country:US
Practice Address - Phone:702-645-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-26
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty