Provider Demographics
NPI:1033133699
Name:CHANG, ANDY CHI (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDY
Middle Name:CHI
Last Name:CHANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 W 15TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7527
Mailing Address - Country:US
Mailing Address - Phone:469-208-9800
Mailing Address - Fax:469-208-9800
Practice Address - Street 1:2831 W 15TH ST
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7527
Practice Address - Country:US
Practice Address - Phone:469-208-9800
Practice Address - Fax:469-208-9800
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189941223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179019801Medicaid