MEDICARE: DR. ZAN J CHANG D.M.D

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	122300000X	Dentist	22DI02372400	NJ

General Provider Information

NPI Number	:	1508029034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZAN J CHANG D.M.D

Provider Business Mailing Address
First Line	:	330 RIDGE RD
Second Line	:
City	:	MAHWAH
State	:	NJ
Zip	:	07430-3613
Country	:	US
Telephone Number	:	201-818-4500
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 RIDGE RD
Second Line	:
City	:	MAHWAH
State	:	NJ
Zip	:	07430-3613
Country	:	US
Telephone Number	:	201-818-4500
Fax Number	:

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

Provider Enumeration Date	:	07/03/2008
Last Update Date	:	07/03/2008

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