Active NPI
Larry Chambers, D.D.S.
- Dentist
- Jackson, TN
National Provider Identifier
1205912219
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS4211
- Practice address
- 3067 N Highland Ave
Jackson, TN 38305-3411 - Phone
- (731) 668-7916
- NPI assigned
- Oct 31, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS4211 | TN | Primary |
Addresses
Primary practice location
3067 N Highland Ave
Jackson, TN 38305-3411
Mailing address
35 Ridgecrest Dr.
Jackson, TN 38305
Phone (731) 668-8907
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 803388 | Other | TN | UCCI |
| 0149768 | Other | TN | BCBS CORP ID# |
| 0132345 | Other | TN | BCBS/TN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS4211 | TN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nothside Dental Center, PA | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- Jackson, TN
- NPI 1700851979
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1205912219",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "35 RIDGECREST DR.",
"city": "JACKSON",
"state": "TN",
"postal_code": "38305",
"telephone_number": "731-668-8907"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3067 N HIGHLAND AVE",
"city": "JACKSON",
"state": "TN",
"postal_code": "383053411",
"telephone_number": "731-668-7916"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAMBERS",
"first_name": "LARRY",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TN",
"license": "DS4211",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCCI",
"identifier": "803388",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS CORP ID#",
"identifier": "0149768",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS/TN",
"identifier": "0132345",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.