Provider Demographics
NPI:1891126405
Name:CHANG, TINA (DDS)
Entity Type:Individual
Prefix:
First Name:TINA
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 1:26400 KUYKENDAHL RD STE A240
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77375-2894
Mailing Address - Country:US
Mailing Address - Phone:832-761-9000
Mailing Address - Fax:
Practice Address - Street 1:26400 KUYKENDAHL RD STE A240
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77375-2894
Practice Address - Country:US
Practice Address - Phone:832-761-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29378122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist