Provider Demographics
NPI:1467494674
Name:CHANG, KENNETH C (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:C
Last Name:CHANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 BALDWIN RD.
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-2007
Mailing Address - Country:US
Mailing Address - Phone:973-335-0840
Mailing Address - Fax:973-338-0801
Practice Address - Street 1:249 BALDWIN RD
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-2007
Practice Address - Country:US
Practice Address - Phone:973-335-0840
Practice Address - Fax:973-335-0801
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 0160671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice