Provider Demographics
NPI:1821002015
Name:CHUANG, BRIAN PO-JEN (DMD, MSCD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:PO-JEN
Last Name:CHUANG
Suffix:
Gender:M
Credentials:DMD, MSCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 LINE ST
Mailing Address - Street 2:APT 2
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-4308
Mailing Address - Country:US
Mailing Address - Phone:978-532-0500
Mailing Address - Fax:978-977-3458
Practice Address - Street 1:6 ESSEX CENTER DR
Practice Address - Street 2:110
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2910
Practice Address - Country:US
Practice Address - Phone:978-532-0500
Practice Address - Fax:978-977-3458
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205961223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics