Provider Demographics
NPI:1639437015
Name:JENNY CHANG DMD, PC
Entity Type:Organization
Organization Name:JENNY CHANG DMD, PC
Other - Org Name:INTERNATIONAL PLACE DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHING-JU
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, SC
Authorized Official - Phone:617-330-8887
Mailing Address - Street 1:1 INTERNATIONAL PL
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-2602
Mailing Address - Country:US
Mailing Address - Phone:617-330-8887
Mailing Address - Fax:617-330-8730
Practice Address - Street 1:1 INTERNATIONAL PL
Practice Address - Street 2:7TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-2602
Practice Address - Country:US
Practice Address - Phone:617-330-8887
Practice Address - Fax:617-330-8730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN19068122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty