Provider Demographics
NPI:1922280643
Name:CHANG, PRISCILLA PAULINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:PAULINE
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 1:80 N NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-3329
Mailing Address - Country:US
Mailing Address - Phone:847-292-0600
Mailing Address - Fax:847-262-0608
Practice Address - Street 1:80 N NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3329
Practice Address - Country:US
Practice Address - Phone:847-292-0600
Practice Address - Fax:847-292-0608
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190273361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice