Provider Demographics
NPI:1932653425
Name:JOSEPH H. CHANG LLC
Entity Type:Organization
Organization Name:JOSEPH H. CHANG LLC
Other - Org Name:CHANDLER DENTAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-361-6691
Mailing Address - Street 1:4960 S GILBERT RD STE 12
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-5982
Mailing Address - Country:US
Mailing Address - Phone:480-361-6691
Mailing Address - Fax:480-361-7252
Practice Address - Street 1:4960 S GILBERT RD STE 12
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-5982
Practice Address - Country:US
Practice Address - Phone:480-361-6691
Practice Address - Fax:480-361-7252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ72811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty