Provider Demographics
NPI:1124172531
Name:CHANG-CHIEN, CHUNG-MING (DDS)
Entity type:Individual
Prefix:
First Name:CHUNG-MING
Middle Name:
Last Name:CHANG-CHIEN
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 1:593 MCGRATH HWY
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-3138
Mailing Address - Country:US
Mailing Address - Phone:617-623-1656
Mailing Address - Fax:617-623-7576
Practice Address - Street 1:593 MCGRATH HWY
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-3138
Practice Address - Country:US
Practice Address - Phone:617-623-1656
Practice Address - Fax:617-623-7576
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA184171223G0001X
NH33721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3073216Medicaid