Provider Demographics
NPI:1548445711
Name:CHANG, PAUL PENG (DDS MS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:PENG
Last Name:CHANG
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N CENTRAL EXPY STE 102
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-3544
Mailing Address - Country:US
Mailing Address - Phone:972-540-5700
Mailing Address - Fax:214-544-8700
Practice Address - Street 1:321 N CENTRAL EXPY STE 102
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-3544
Practice Address - Country:US
Practice Address - Phone:972-540-5700
Practice Address - Fax:214-544-8700
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0373801223P0300X
TX237541223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics