Provider Demographics
NPI:1194970848
Name:CHANG, VERONICA (DDS)
Entity type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 COLBY STREET
Mailing Address - Street 2:217
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2060
Mailing Address - Country:US
Mailing Address - Phone:510-705-1461
Mailing Address - Fax:
Practice Address - Street 1:3010 COLBY ST
Practice Address - Street 2:217
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2091
Practice Address - Country:US
Practice Address - Phone:510-705-1461
Practice Address - Fax:510-705-1665
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADU384021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice