Provider Demographics
NPI:1295953750
Name:CHANG, QUYEN DUONG (DDS)
Entity type:Individual
Prefix:DR
First Name:QUYEN
Middle Name:DUONG
Last Name:CHANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:QUYEN
Other - Middle Name:DUONG
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3388 SIX FORKS RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7233
Mailing Address - Country:US
Mailing Address - Phone:919-783-6551
Mailing Address - Fax:
Practice Address - Street 1:3388 SIX FORKS RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7233
Practice Address - Country:US
Practice Address - Phone:919-783-6551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC56591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice