Provider Demographics
NPI:1053006817
Name:CHANG DENTAL GROUP
Entity type:Organization
Organization Name:CHANG DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-467-9145
Mailing Address - Street 1:12080 N DOVE MOUNTAIN BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85658-4553
Mailing Address - Country:US
Mailing Address - Phone:520-367-2742
Mailing Address - Fax:
Practice Address - Street 1:12080 N DOVE MOUNTAIN BLVD STE 140
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85658-4553
Practice Address - Country:US
Practice Address - Phone:520-367-2742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty