Provider Demographics
NPI:1417846866
Name:CHANG, VANESSA EUNSAEM (DMD, MPH)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:EUNSAEM
Last Name:CHANG
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5105 ELDORADO PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-8676
Mailing Address - Country:US
Mailing Address - Phone:214-387-0745
Mailing Address - Fax:
Practice Address - Street 1:5105 ELDORADO PKWY STE 150
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-8676
Practice Address - Country:US
Practice Address - Phone:214-387-0745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX414921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program