Provider Demographics
NPI:1972284230
Name:FIRST AVENUE DENTAL & ORTHODONTICS GROUP
Entity Type:Organization
Organization Name:FIRST AVENUE DENTAL & ORTHODONTICS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:626-818-0633
Mailing Address - Street 1:65 N 1ST AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3256
Mailing Address - Country:US
Mailing Address - Phone:626-254-9066
Mailing Address - Fax:
Practice Address - Street 1:65 N 1ST AVE STE 203
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3256
Practice Address - Country:US
Practice Address - Phone:626-254-9066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty