Provider Demographics
NPI:1891382560
Name:FANG, MEIXIAN (RDA)
Entity Type:Individual
Prefix:
First Name:MEIXIAN
Middle Name:
Last Name:FANG
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E SOUTHWEST PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-8753
Mailing Address - Country:US
Mailing Address - Phone:469-630-1369
Mailing Address - Fax:
Practice Address - Street 1:101 E SOUTHWEST PKWY STE 103
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-8753
Practice Address - Country:US
Practice Address - Phone:469-630-1369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX97006126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant