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Organization

MIDWEST FAMILY DENTAL, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. RANDOLPH CHANG DDS (MEMBER)
(773) 267-8600
Entity
Organization

Contact information

Practice address
916 N GREEN BAY RD, WAUKEGAN, IL 60085-2240
(773) 267-8600
(773) 267-8601
Mailing address
916 N GREEN BAY RD, WAUKEGAN, IL 60085-2240
(773) 267-8600
(773) 267-8601

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary

Other

Enumeration date
09/16/2014
Last updated
09/16/2014
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