Provider Demographics
NPI:1851452031
Name:CHANG, AMOS C (DDS)
Entity type:Individual
Prefix:DR
First Name:AMOS
Middle Name:C
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 1:50 TAIN DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4435
Mailing Address - Country:US
Mailing Address - Phone:516-487-1063
Mailing Address - Fax:
Practice Address - Street 1:3907 PRINCE ST
Practice Address - Street 2:SUITE 5E
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5399
Practice Address - Country:US
Practice Address - Phone:718-461-9311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040222122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist