Provider Demographics
NPI:1609105600
Name:MICHAEL W. CHANG, DDS, PLLC
Entity Type:Organization
Organization Name:MICHAEL W. CHANG, DDS, PLLC
Other - Org Name:APPALACHIAN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-255-4848
Mailing Address - Street 1:PO BOX 1328
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20122-8328
Mailing Address - Country:US
Mailing Address - Phone:703-385-2772
Mailing Address - Fax:703-935-2492
Practice Address - Street 1:3903 FAIR RIDGE DR
Practice Address - Street 2:SUITE 207
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2906
Practice Address - Country:US
Practice Address - Phone:703-385-2772
Practice Address - Fax:703-935-2492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014123591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty