Provider Demographics
NPI:1124097365
Name:KEITH D. CHAMBERS, D.M.D.,P.S.C.
Entity type:Organization
Organization Name:KEITH D. CHAMBERS, D.M.D.,P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-451-0888
Mailing Address - Street 1:401 BOGLE ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2850
Mailing Address - Country:US
Mailing Address - Phone:606-451-0888
Mailing Address - Fax:606-451-0889
Practice Address - Street 1:401 BOGLE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2850
Practice Address - Country:US
Practice Address - Phone:606-451-0888
Practice Address - Fax:606-451-0889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY66601223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65937088Medicaid
KY61900577Medicaid