Provider Demographics
NPI:1366624710
Name:CHANG, LIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LIN
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E CORPORATE DR
Mailing Address - Street 2:STE. 120
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-6603
Mailing Address - Country:US
Mailing Address - Phone:972-459-5608
Mailing Address - Fax:972-459-5638
Practice Address - Street 1:101 E CORPORATE DR
Practice Address - Street 2:STE. 120
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-6603
Practice Address - Country:US
Practice Address - Phone:972-459-5608
Practice Address - Fax:972-459-5638
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice