Provider Demographics
NPI:1659010874
Name:CHANG, ELLEN JULIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:JULIA
Last Name:CHANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 CALVERT AVE E
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3262
Mailing Address - Country:US
Mailing Address - Phone:732-570-8920
Mailing Address - Fax:
Practice Address - Street 1:520 S OXFORD VALLEY RD
Practice Address - Street 2:
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030-2615
Practice Address - Country:US
Practice Address - Phone:215-608-3868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-04
Last Update Date:2022-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS043680122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist