Basic Information
| Provider Information | |||||||||
| NPI: | 1235401506 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHIANG | ||||||||
| FirstName: | EVA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 SW 2ND AVE | ||||||||
| Address2: | APT # 105 | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334324762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618430159 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3200 S UNIVERSITY DR | ||||||||
| Address2: | SANFORD L. ZIFF BLDG. | ||||||||
| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333282018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542627500 | ||||||||
| FaxNumber: | 9542627164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2012 | ||||||||
| LastUpdateDate: | 02/02/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DTP563 | FL | Y | Dental Providers | Dentist | General Practice |
No ID Information.