Provider Demographics
NPI:1801195706
Name:101 DENTAL & ORTHODONTICS
Entity Type:Organization
Organization Name:101 DENTAL & ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-686-3139
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-18
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23239122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty