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DR. MICHELLE G. CHANG, DMD, PLLC

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Company Details

Legal Name: DR. MICHELLE G. CHANG, DMD, PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Active
Formation/ Registration Date: February 8th 2021
Expiration date: 28 Feb 2026
UBI Number: 604 710 334
ZIP code: 98059
City: Renton
County: KING
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 1620 DUVALL AVE NE, SUITE A, RENTON, WA, 98059-3975, UNITED STATES

Contact Details

E-Mail: MICHELLECHANGDMD@GMAIL.COM

Nature of Business

Health Care, Social Assistance & Service Organization, DENTISTRY

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Registered Agent Information

Name Role Address
MICHELLE CHANG Registered Agent 1620 DUVALL AVE NE, RENTON, WA, 98059-3975, UNITED STATES

Key Officers & Management

Name Role Address
MATTHEW VAN WAGONER Executor 201 S MAIN ST STE 1800, SALT LAKE CTY, UT, 84111-2218, UNITED STATES
MICHELLE CHANG Governing Person -

National Provider Identifier

NPI Number:
1275105033
Certification Date:
2021-07-12

Authorized Person:

Name:
AARON FORDHAM
Role:
ADMINISTRATOR
Phone:

Taxonomy:

Selected Taxonomy:
1223G0001X - General Practice Dentistry
Is Primary:
Yes

Contacts:

Form 5500 Series

Employer Identification Number (EIN):
863222119
Plan Year:
2024
Number Of Participants:
12
Plan Name:
401(K)
Sponsor's telephone number:
Plan Administrator / Signatory:
ERISA FIDUCIARY SERVICES(Plan administrator)
Plan Year:
2023
Number Of Participants:
11
Plan Name:
401(K)
Sponsor's telephone number:
Plan Administrator / Signatory:
ERISA FIDUCIARY SERVICES(Plan administrator)
Plan Year:
2022
Number Of Participants:
13
Plan Name:
401(K)
Sponsor's telephone number:
Plan Administrator / Signatory:
ERISA FIDUCIARY SERVICES(Plan administrator)
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