Provider Demographics
NPI:1285724021
Name:CHAMBERS, RACHAEL ANNETTE (EFDA)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:ANNETTE
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:EFDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18909 SE GRANT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233
Mailing Address - Country:US
Mailing Address - Phone:503-492-1481
Mailing Address - Fax:
Practice Address - Street 1:7201 N INTERSTATE
Practice Address - Street 2:NORTH INTERSTATE DENTAL
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-5523
Practice Address - Country:US
Practice Address - Phone:503-240-4051
Practice Address - Fax:503-240-4024
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR112057126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant