Provider Demographics
NPI:1750728929
Name:CHANG, PETER KAO (DMD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:KAO
Last Name:CHANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4512 POST RD
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-4124
Mailing Address - Country:US
Mailing Address - Phone:401-884-2190
Mailing Address - Fax:401-885-2295
Practice Address - Street 1:4512 POST RD
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-4124
Practice Address - Country:US
Practice Address - Phone:401-884-2190
Practice Address - Fax:401-885-2295
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN031711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice