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General NPI Number Information
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NPI Number | 1366163842
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Entity Type | Individual
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Provider Name | YILIAN Y LABORDE CHANG DMD
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Gender | Female
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Dates
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Enumeration Date | 09/05/2022
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 17136 SE 109TH TERRACE RD
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City | SUMMERFIELD
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State | FL
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Zip | 34491-9031
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Country | US
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Telephone | 786-643-7710
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Fax |
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Provider Business Mailing Address
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Address Line | 3443 NE 13TH ST
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City | OCALA
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State | FL
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Zip | 34470-6401
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Country | US
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Telephone | 786-643-7710
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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 | 27509
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 27509
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License Number State | FL
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