Individual
DR. PE CHANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
7111 PROSPECT PL NE, SUITE B, ALBUQUERQUE, NM 87110-4309
(505) 888-5131
(505) 888-5135
Mailing address
6800 VISTA DEL NORTE RD NE, UNIT #1526, ALBUQUERQUE, NM 87113-1311
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD2344
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018016
—
NM
01
—
1505220
UNITED CONCORDIA
NM
05
—
55120725
—
NM
Enumeration date
09/20/2006
Last updated
10/27/2017
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