Provider Demographics
NPI:1194953133
Name:CHAMBERLAIN, JUDD MCKAY (DDS)
Entity type:Individual
Prefix:DR
First Name:JUDD
Middle Name:MCKAY
Last Name:CHAMBERLAIN
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 1:1190 BOOKCLIFF AVE UNIT 101
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8159
Mailing Address - Country:US
Mailing Address - Phone:970-245-2990
Mailing Address - Fax:970-298-1726
Practice Address - Street 1:1190 BOOKCLIFF AVE UNIT 101
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8159
Practice Address - Country:US
Practice Address - Phone:970-245-2990
Practice Address - Fax:970-298-1726
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10141122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66732280Medicaid