Provider Demographics
NPI:1316469323
Name:CHARLES CHANG, DDS, MS, PLLC
Entity type:Organization
Organization Name:CHARLES CHANG, DDS, MS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-577-7257
Mailing Address - Street 1:7713 CENTER BLVD SE STE 240
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-6319
Mailing Address - Country:US
Mailing Address - Phone:425-577-7257
Mailing Address - Fax:
Practice Address - Street 1:7713 CENTER BLVD SE STE 240
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-6319
Practice Address - Country:US
Practice Address - Phone:425-577-7257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty