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General NPI Number Information
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NPI Number | 1053205286
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Entity Type | Individual
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Provider Name | TIEN-CHI CHANG DDS
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Gender | Male
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Dates
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Enumeration Date | 06/04/2025
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 590 FOOTHILL BLVD
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City | SALT LAKE CITY
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State | UT
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Zip | 84113-1106
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Country | US
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Telephone | 801-584-1206
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Fax |
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Provider Business Mailing Address
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Address Line | 500 FOOTHILL DR
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City | SALT LAKE CITY
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State | UT
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Zip | 84148-0001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 14216373-9926
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License Number State | UT
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