MEDICARE: DR. STUART D CHANG D.D.S.

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	47600	CA

General Provider Information

NPI Number	:	1205930658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STUART D CHANG D.D.S.

Provider Business Mailing Address
First Line	:	3809 PLAZA DR STE 114
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-4625
Country	:	US
Telephone Number	:	760-945-1111
Fax Number	:

Provider Business Practice Location Address
First Line	:	3809 PLAZA DR STE 114
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-4625
Country	:	US
Telephone Number	:	760-945-1111
Fax Number	:

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

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. STUART D CHANG D.D.S.” Practice Location

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