Brice Chang, D.D.S.
Individual provider
Active NPI
Dentist · Brookings, OR
NPI 1831276641 · NPPES record last updated Apr 7, 2021
Key facts
- NPI
- 1831276641
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D8019 (OR)
- Practice address
- 350 Pacific Ave Ste 101
Brookings, OR 97415-0241
- Phone
- (541) 469-0192
- Fax
- (360) 892-8902
- NPI assigned
- Nov 1, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|
| I20250421003130 |
OR |
Order and Referring Only - Dentist
Practitioner - Dentist |
2163723685 |
|
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|
| D8019 | OR | MD | Dentist |
| D00009300 | WA | MD | General Practice Dentistry |
Practice roles
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|
| General Practice Dentistry |
1223G0001X |
D00009300 |
WA |
|
| Dentist |
122300000X |
D8019 |
OR |
Yes |
Addresses
Primary practice location
350 Pacific Ave Ste 101
Brookings, OR 97415-0241
Mailing address
350 Pacific Ave
P.O. Box 4370
Brookings, OR 97415
Phone (541) 469-0192
Other identifiers
| Identifier | Type | State | Issuer |
|---|
| 5044482 | Medicaid | WA | |