Provider Demographics
NPI:1841335221
Name:CHANG, JAMES W
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
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 1:1472 BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48340-1102
Mailing Address - Country:US
Mailing Address - Phone:248-332-2448
Mailing Address - Fax:248-332-7401
Practice Address - Street 1:1472 BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-1102
Practice Address - Country:US
Practice Address - Phone:248-332-2448
Practice Address - Fax:248-332-7401
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1124701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4059338Medicare ID - Type Unspecified