Provider Demographics
NPI:1568773687
Name:CHANG, ERIC (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
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 1:13633 37TH AVE STE 5C
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4562
Mailing Address - Country:US
Mailing Address - Phone:718-321-8006
Mailing Address - Fax:718-321-8005
Practice Address - Street 1:13633 37TH AVE STE 5C
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4562
Practice Address - Country:US
Practice Address - Phone:718-321-8006
Practice Address - Fax:718-321-8005
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055746-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03404271Medicaid