Provider Demographics
NPI:1477667657
Name:CHANG-ANDING, MICHELLE LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LEE
Last Name:CHANG-ANDING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:LEE
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2430 SOUTH 73 STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124
Mailing Address - Country:US
Mailing Address - Phone:402-933-4632
Mailing Address - Fax:402-933-5236
Practice Address - Street 1:2430 SOUTH 73 STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124
Practice Address - Country:US
Practice Address - Phone:402-933-4632
Practice Address - Fax:402-933-5236
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-19621223G0001X
NE61511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100250728-00Medicaid
NE4618OtherBLUE CROSS BLUE SHIELD
NE978843OtherUNITED CONCORDIA