Provider Demographics
NPI:1942313317
Name:CHANG, RICHARD EDWARD (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:EDWARD
Last Name:CHANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8137 SUNSET AVE
Mailing Address - Street 2:#130
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628
Mailing Address - Country:US
Mailing Address - Phone:916-961-1901
Mailing Address - Fax:916-961-5012
Practice Address - Street 1:8137 SUNSET AVE
Practice Address - Street 2:#130
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628
Practice Address - Country:US
Practice Address - Phone:916-961-1901
Practice Address - Fax:916-961-5012
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30088122300000X
WI2555122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist