Provider Demographics
NPI:1306175872
Name:CHAMBERLIN, JULIE (RDH)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:CHAMBERLIN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4023 BUTLER LN
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-5055
Mailing Address - Country:US
Mailing Address - Phone:970-206-9132
Mailing Address - Fax:970-206-9132
Practice Address - Street 1:4023 BUTLER LN
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-5055
Practice Address - Country:US
Practice Address - Phone:970-206-9132
Practice Address - Fax:970-206-9132
Is Sole Proprietor?:No
Enumeration Date:2009-12-13
Last Update Date:2009-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO903490124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist