Individual provider Active NPI

Judd McKay Chamberlain, DDS

  • Dentist
  • Grand Junction, CO
National Provider Identifier
1194953133
Registry record updated Oct 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
10141 Issued in CO
Practice address
1190 Bookcliff Ave Unit 101
Grand Junction, CO 81501-8159
Phone
(970) 245-2990
Fax
(970) 298-1726
NPI assigned
Jun 29, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 10141 CO Primary

Addresses

Primary practice location

1190 Bookcliff Ave Unit 101
Grand Junction, CO 81501-8159

Mailing address

1190 Bookcliff Ave Unit 101
Grand Junction, CO 81501-8159
Phone (970) 245-2990

Other identifiers 1

IdentifierTypeStateIssuer
66732280MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160111001807 CO Practitioner - Oral Surgery 0648572404

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10141COMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Judd M Chamberlain, DDS, PC Dentist CurrentSince Oct 22, 2023 Accepting new patients

Locations

1190 Bookcliff Ave
Unit 101
Grand Junction, CO 81501
Phone (970) 242-1900

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1246233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697414400000",
    "number": "1194953133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1190 BOOKCLIFF AVE UNIT 101",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815018159",
            "telephone_number": "970-245-2990",
            "fax_number": "970-298-1726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1190 BOOKCLIFF AVE UNIT 101",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815018159",
            "telephone_number": "970-245-2990",
            "fax_number": "970-298-1726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAMBERLAIN",
        "first_name": "JUDD",
        "middle_name": "MCKAY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-29",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "10141",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "66732280",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Junction, CO

Sources for this page

Verify at the official NPI Registry.