Provider Demographics
NPI:1023492386
Name:MICHAEL W CHANG DDS
Entity type:Organization
Organization Name:MICHAEL W CHANG DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-505-6235
Mailing Address - Street 1:236 S 3RD ST
Mailing Address - Street 2:STE E
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3618
Mailing Address - Country:US
Mailing Address - Phone:970-306-4548
Mailing Address - Fax:720-368-5095
Practice Address - Street 1:236 S 3RD ST
Practice Address - Street 2:STE E
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3618
Practice Address - Country:US
Practice Address - Phone:970-306-4548
Practice Address - Fax:720-368-5095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014123591223G0001X
CO89121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02558294Medicaid
CO74405519Medicaid