Provider Demographics
NPI:1821009119
Name:CHANG, PEGGY (DDS)
Entity Type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:PEI-YI
Other - Middle Name:
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15945 NE 85TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3531
Mailing Address - Country:US
Mailing Address - Phone:425-885-1116
Mailing Address - Fax:425-861-6756
Practice Address - Street 1:15945 NE 85TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3531
Practice Address - Country:US
Practice Address - Phone:425-885-1116
Practice Address - Fax:425-861-6756
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000090611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice