Provider Demographics
NPI:1821169947
Name:CHANG, JULIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8708 JUSTICE AVE
Mailing Address - Street 2:SUITE 2M
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4575
Mailing Address - Country:US
Mailing Address - Phone:718-898-3702
Mailing Address - Fax:718-898-3702
Practice Address - Street 1:8708 JUSTICE AVE
Practice Address - Street 2:SUITE 2M
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4575
Practice Address - Country:US
Practice Address - Phone:718-898-3702
Practice Address - Fax:718-898-3702
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0454791223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics