MEDICARE: DR. SU-WEN CHANG D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5807	AZ

General Provider Information

NPI Number	:	1073722831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SU-WEN CHANG D.D.S.

Provider Business Mailing Address
First Line	:	5340 E BROADWAY BLVD STE 150
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-3714
Country	:	US
Telephone Number	:	520-748-8186
Fax Number	:	520-514-7518

Provider Business Practice Location Address
First Line	:	5340 E BROADWAY BLVD STE 150
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-3714
Country	:	US
Telephone Number	:	520-748-8186
Fax Number	:	520-514-7518

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	12/30/2024

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