Provider Demographics
NPI:1386970812
Name:CHANG, DAWN M (DMD)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:M
Last Name:CHANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1061 KAIULIULI ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6438
Mailing Address - Country:US
Mailing Address - Phone:808-342-8939
Mailing Address - Fax:
Practice Address - Street 1:555 FARRINGTON HWY STE 1
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2052
Practice Address - Country:US
Practice Address - Phone:808-342-8939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-17
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT1479122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist