Provider Demographics
NPI:1003036286
Name:CHANG, JEFFREY CHAI (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CHAI
Last Name:CHANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:CHAI
Other - Middle Name:NMN
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:38TH STREET, BLDG 38717
Mailing Address - Street 2:USA DENTAC
Mailing Address - City:FT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5660
Mailing Address - Country:US
Mailing Address - Phone:706-787-6927
Mailing Address - Fax:706-787-2081
Practice Address - Street 1:38TH STREET, BLDG 38717
Practice Address - Street 2:USA DENTAC
Practice Address - City:FT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5660
Practice Address - Country:US
Practice Address - Phone:706-787-6927
Practice Address - Fax:706-787-2081
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17324122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223P0700XDental ProvidersDentistProsthodontics