Provider Demographics
NPI:1538869029
Name:CHANG, BRIAN WEN (DMD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:WEN
Last Name:CHANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 W HAMILTON ST APT 210
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18101-1132
Mailing Address - Country:US
Mailing Address - Phone:734-223-7983
Mailing Address - Fax:
Practice Address - Street 1:2690 KINGSTON RD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-8001
Practice Address - Country:US
Practice Address - Phone:610-810-2704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.027456122300000X
PADS044523122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist