Provider Demographics
NPI:1568907426
Name:WANG, ELIJAH CHANG (MS, DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIJAH
Middle Name:CHANG
Last Name:WANG
Suffix:
Gender:M
Credentials:MS, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 RASPBERRY CT
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-2050
Mailing Address - Country:US
Mailing Address - Phone:408-386-9401
Mailing Address - Fax:
Practice Address - Street 1:5129 N GARLAND AVE
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-2725
Practice Address - Country:US
Practice Address - Phone:972-276-5191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002030331223X0400X
TX345931223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics