Provider Demographics
NPI:1417019381
Name:CHANG, JASON C (DMDMS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:C
Last Name:CHANG
Suffix:
Gender:M
Credentials:DMDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 PARK ROW
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-1127
Mailing Address - Country:US
Mailing Address - Phone:212-385-9399
Mailing Address - Fax:
Practice Address - Street 1:180 PARK ROW
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-1127
Practice Address - Country:US
Practice Address - Phone:212-385-9399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI020395001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics