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General NPI Number Information
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NPI Number | 1639287576
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Entity Type | Individual
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Provider Name | MILLIE MARY CHANG DDS
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Gender | Female
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 09/25/2009
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Provider Practice Location Address
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Address Line | 8136 BASH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2000
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Country | US
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Telephone | 317-577-6453
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Fax | 317-577-6456
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Provider Business Mailing Address
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Address Line | 3959 CHADWICK DR
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City | CARMEL
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State | IN
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Zip | 46033-4810
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Country | US
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Telephone | 317-569-0281
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12010347A
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License Number State | IN
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