MEDICARE: CHER Y CHANG DMD

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	4862	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4862	OTHER	NV	DENTAL LICENSE

General Provider Information

NPI Number	:	1255419420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHER Y CHANG DMD

Provider Business Mailing Address
First Line	:	4415 SPRING MOUNTAIN RD STE 103
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8758
Country	:	US
Telephone Number	:	702-307-5414
Fax Number	:	702-307-5421

Provider Business Practice Location Address
First Line	:	4415 SPRING MOUNTAIN RD STE 103
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8758
Country	:	US
Telephone Number	:	702-307-5414
Fax Number	:	702-307-5421

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	07/08/2007

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Directions to “ CHER Y CHANG DMD” Practice Location

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