Provider Demographics
NPI:1275105033
Name:DR. MICHELLE G. CHANG DMD PLLC
Entity Type:Organization
Organization Name:DR. MICHELLE G. CHANG DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:FORDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-736-3739
Mailing Address - Street 1:1620 DUVALL AVE NE STE A
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-3975
Mailing Address - Country:US
Mailing Address - Phone:425-271-6002
Mailing Address - Fax:
Practice Address - Street 1:1620 DUVALL AVE NE STE A
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-3975
Practice Address - Country:US
Practice Address - Phone:425-271-6002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty