Theodore K Chang, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22DI02565000 Issued in NJ

Practice address

749 Bloomfield Ave Ste D
West Caldwell, NJ 07006

Phone

(646) 673-4496

NPI assigned

Feb 12, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Blooming Dental & Implant Center of Rockaway LLC

  • General Practice Dentistry
  • Rockaway, NJ
  • NPI 1528865128
  NPD Authorized official
• Blooming Family Dental LLC

  • General Practice Dentistry
  • West Caldwell, NJ
  • NPI 1699261347
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1360627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594944000000",
    "number": "1871832774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "749 BLOOMFIELD AVE STE D",
            "city": "WEST CALDWELL",
            "state": "NJ",
            "postal_code": "070066717",
            "telephone_number": "646-484-9404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "749 BLOOMFIELD AVE STE D",
            "city": "WEST CALDWELL",
            "state": "NJ",
            "postal_code": "07006",
            "telephone_number": "646-673-4496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANG",
        "first_name": "THEODORE",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-02-12",
        "last_updated": "2020-07-17",
        "certification_date": "2020-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI02565000",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "057487",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anthony Castellano, D.M.D.
• Dana Catalano
• Jason Peter Cecilio
• Erik Albert Chamberjian, D.C.
• Julie Chang
• Jacob Orestes Charpentier, MSAT, ATC
• David Chen, MD
• Amy Cheung
• Grace F Chin, RPH
• Charles Chirackal, DPT

• General Practice Dentistry in West Caldwell, NJ
• Providers in West Caldwell, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.