MEDICARE: DR. MARY ANN CHANG DMD, MDS

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	6869	KS

General Provider Information

NPI Number	:	1134107121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY ANN CHANG DMD, MDS

Provider Business Mailing Address
First Line	:	9314 E CENTRAL AVE
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-2555
Country	:	US
Telephone Number	:	316-686-6565
Fax Number	:	316-866-2563

Provider Business Practice Location Address
First Line	:	9314 E CENTRAL AVE
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-2555
Country	:	US
Telephone Number	:	316-686-6565
Fax Number	:	316-866-2563

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

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	01/29/2009

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