Provider Demographics
NPI:1053433987
Name:CHANG, CHING-JU JENNY (DMD)
Entity type:Individual
Prefix:DR
First Name:CHING-JU
Middle Name:JENNY
Last Name:CHANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 COMMON ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-4713
Mailing Address - Country:US
Mailing Address - Phone:508-653-6771
Mailing Address - Fax:508-653-5654
Practice Address - Street 1:19 COMMON ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-4713
Practice Address - Country:US
Practice Address - Phone:508-653-6771
Practice Address - Fax:508-653-5654
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA190681223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics