Provider Demographics
NPI:1629527593
Name:CHANG, JULIET (DMD, MSD)
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 SPRING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-7734
Mailing Address - Country:US
Mailing Address - Phone:818-825-2833
Mailing Address - Fax:
Practice Address - Street 1:3801 LAS POSAS RD STE 205
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1426
Practice Address - Country:US
Practice Address - Phone:805-388-1730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN112481223P0300X
CA1072351223P0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program