Provider Demographics
NPI:1205961372
Name:CHANG, RANDALL ERIC (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:ERIC
Last Name:CHANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:3050 CITRUS CIR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2698
Mailing Address - Country:US
Mailing Address - Phone:925-938-2392
Mailing Address - Fax:925-938-2394
Practice Address - Street 1:3050 CITRUS CIR
Practice Address - Street 2:SUITE 110
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2698
Practice Address - Country:US
Practice Address - Phone:925-938-2392
Practice Address - Fax:925-938-2394
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA500451223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry