Provider Demographics
NPI:1376956201
Name:EDDIE CHANG DENTAL PRACTICE INC
Entity Type:Organization
Organization Name:EDDIE CHANG DENTAL PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-228-3517
Mailing Address - Street 1:166 W COLLEGE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-2047
Mailing Address - Country:US
Mailing Address - Phone:626-331-0688
Mailing Address - Fax:626-915-2213
Practice Address - Street 1:166 W COLLEGE ST
Practice Address - Street 2:SUITE C
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-2047
Practice Address - Country:US
Practice Address - Phone:626-331-0688
Practice Address - Fax:626-915-2213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA463671223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty