Provider Demographics
NPI:1396265203
Name:CHANG, DENNIS WILLIAM
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:WILLIAM
Last Name:CHANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 N ST SE BLDG 175
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON NAVY YARD
Mailing Address - State:DC
Mailing Address - Zip Code:20374-5162
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:915 N ST SE BLDG 175
Practice Address - Street 2:
Practice Address - City:WASHINGTON NAVY YARD
Practice Address - State:DC
Practice Address - Zip Code:20374-5162
Practice Address - Country:US
Practice Address - Phone:202-433-0813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MADN18577261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program