Provider Demographics
NPI:1467000844
Name:DR.CHANG FAMILY DENTISTRY
Entity Type:Organization
Organization Name:DR.CHANG FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CANAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-475-0999
Mailing Address - Street 1:32315 MISSION BLVD
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-8258
Mailing Address - Country:US
Mailing Address - Phone:510-475-0999
Mailing Address - Fax:510-400-9048
Practice Address - Street 1:32315 MISSION BLVD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-8258
Practice Address - Country:US
Practice Address - Phone:510-475-0999
Practice Address - Fax:510-400-9048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty