Provider Demographics
NPI:1033143987
Name:SU-WEN CHANG, D.D.S., P.C.
Entity Type:Organization
Organization Name:SU-WEN CHANG, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SU-WEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-748-8186
Mailing Address - Street 1:350 S WILLIAMS BLVD
Mailing Address - Street 2:#240
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-4496
Mailing Address - Country:US
Mailing Address - Phone:520-748-8186
Mailing Address - Fax:520-514-7518
Practice Address - Street 1:350 S WILLIAMS BLVD
Practice Address - Street 2:#240
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-4496
Practice Address - Country:US
Practice Address - Phone:520-748-8186
Practice Address - Fax:520-514-7518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ58071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty