Healthcare Provider Details

I. General information

NPI: 1326011370
Provider Name (Legal Business Name): LLOYD CHANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 NE BURNSIDE RD SUITE 801
GRESHAM OR
97030-6722
US

IV. Provider business mailing address

1217 NE BURNSIDE RD SUITE 801
GRESHAM OR
97030-6722
US

V. Phone/Fax

Practice location:
  • Phone: 503-666-1505
  • Fax: 503-666-7218
Mailing address:
  • Phone: 503-666-1505
  • Fax: 503-666-7218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD8419
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: