Provider Demographics
NPI:1871789305
Name:CHUNG, MICHAEL J (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 LERNARD RD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-7912
Mailing Address - Country:US
Mailing Address - Phone:732-780-8308
Mailing Address - Fax:
Practice Address - Street 1:535 IRON BRIDGE RD
Practice Address - Street 2:SUITE 9
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-5301
Practice Address - Country:US
Practice Address - Phone:732-308-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023300001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics