Provider Demographics
NPI:1689994204
Name:CHANG, DANIEL E (DMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:CHANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5652 VINEVALE CIR
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-2114
Mailing Address - Country:US
Mailing Address - Phone:562-552-7662
Mailing Address - Fax:
Practice Address - Street 1:312 N CENTRAL EXPY
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-3520
Practice Address - Country:US
Practice Address - Phone:214-842-8825
Practice Address - Fax:214-842-8971
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-04
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA578621223G0001X
TX288071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice