Provider Demographics
NPI:1063617546
Name:CHAMBERS, CORY J (DDS)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:J
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9405 N PENNSYLVANIA PL
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-3801
Mailing Address - Country:US
Mailing Address - Phone:405-753-9090
Mailing Address - Fax:405-755-6896
Practice Address - Street 1:9405 N PENNSYLVANIA PL
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-3801
Practice Address - Country:US
Practice Address - Phone:405-753-9090
Practice Address - Fax:405-755-6896
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK59411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice