Provider Demographics
NPI:1588649909
Name:CHANG, MATTHEW WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:WILLIAM
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 1:250 MAKALAPA DR
Mailing Address - Street 2:COMPACFLT HEALTH SERVICES (N01HD), ATTN PROF AFF COORD
Mailing Address - City:PEARL HARBOR
Mailing Address - State:HI
Mailing Address - Zip Code:96860-3131
Mailing Address - Country:US
Mailing Address - Phone:619-321-8721
Mailing Address - Fax:
Practice Address - Street 1:250 MAKALAPA DR
Practice Address - Street 2:COMPACFLT HEALTH SERVICES (N01HD), ATTN: PROF AFF COORD
Practice Address - City:PEARL HARBOR
Practice Address - State:HI
Practice Address - Zip Code:96860-3131
Practice Address - Country:US
Practice Address - Phone:619-572-3850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0516111223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health