Provider Demographics
NPI:1841555950
Name:CHANG, TIMOTHY (DDS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:919-307-4464
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:919-307-4464
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 60281332122300000X
NC9289122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist