MEDICARE: MR. PAUL 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	5774	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215980750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL CHANG D.D.S.

Provider Business Mailing Address
First Line	:	P.O. BOX 30060
Second Line	:
City	:	LAUGHLIN
State	:	NV
Zip	:	89028-0192
Country	:	US
Telephone Number	:	928-234-3078
Fax Number	:	928-763-8801

Provider Business Practice Location Address
First Line	:	3003 HIGHWAY 95
Second Line	:	SUITE B-33
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-7860
Country	:	US
Telephone Number	:	928-763-8750
Fax Number	:	928-763-8801

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	05/18/2010

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Directions to “ MR. PAUL CHANG D.D.S.” Practice Location

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