Provider Demographics
NPI:1780037838
Name:CHANG, CHIEH TING (DMD, MS)
Entity Type:Individual
Prefix:
First Name:CHIEH TING
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5819 HIGHWAY 6 STE 210
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4069
Mailing Address - Country:US
Mailing Address - Phone:281-499-3275
Mailing Address - Fax:
Practice Address - Street 1:5819 HIGHWAY 6 STE 210
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4069
Practice Address - Country:US
Practice Address - Phone:281-499-3275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX318611223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry