Provider Demographics
NPI:1700146966
Name:E LINE ORTHODONTICS
Entity Type:Organization
Organization Name:E LINE ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOON
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-242-2040
Mailing Address - Street 1:1017 E TRINITY MILLS RD
Mailing Address - Street 2:102
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-1438
Mailing Address - Country:US
Mailing Address - Phone:972-242-2040
Mailing Address - Fax:972-446-0088
Practice Address - Street 1:3044 OLD DENTON RD
Practice Address - Street 2:STE. 111-304
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5016
Practice Address - Country:US
Practice Address - Phone:972-242-2040
Practice Address - Fax:972-446-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX271281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty