Provider Demographics
NPI:1215070818
Name:CHANG, JUDY D (DDS)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:D
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 1:1883 E WATTLES RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-5082
Mailing Address - Country:US
Mailing Address - Phone:248-619-9393
Mailing Address - Fax:248-689-9900
Practice Address - Street 1:1883 E WATTLES RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-5082
Practice Address - Country:US
Practice Address - Phone:248-619-9393
Practice Address - Fax:248-689-9900
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010112481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice