Provider Demographics
NPI:1275530610
Name:CHANG, MAY M (DDS, PC)
Entity Type:Individual
Prefix:DR
First Name:MAY
Middle Name:M
Last Name:CHANG
Suffix:
Gender:F
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1744 NE 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1527
Mailing Address - Country:US
Mailing Address - Phone:503-287-0072
Mailing Address - Fax:503-517-0113
Practice Address - Street 1:1744 NE 42ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1527
Practice Address - Country:US
Practice Address - Phone:503-287-0072
Practice Address - Fax:503-517-0113
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice