Provider Demographics
NPI:1487916789
Name:SCHAMBEAU DENTAL CARE, P.C.
Entity type:Organization
Organization Name:SCHAMBEAU DENTAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MCGOWIN
Authorized Official - Last Name:SCHAMBEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-428-2205
Mailing Address - Street 1:6260 PARK SOUTH DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-5655
Mailing Address - Country:US
Mailing Address - Phone:205-428-2205
Mailing Address - Fax:
Practice Address - Street 1:6260 PARK SOUTH DR
Practice Address - Street 2:SUITE 101
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-5655
Practice Address - Country:US
Practice Address - Phone:205-428-2205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL47371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty