Provider Demographics
NPI:1861846255
Name:CHANG, FU-TING (DMD)
Entity type:Individual
Prefix:DR
First Name:FU-TING
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 SAM BASS RD STE 108
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-2001
Mailing Address - Country:US
Mailing Address - Phone:737-220-1800
Mailing Address - Fax:737-220-1818
Practice Address - Street 1:2000 SAM BASS RD STE 108
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-2001
Practice Address - Country:US
Practice Address - Phone:737-220-1800
Practice Address - Fax:737-220-1818
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015483122300000X
390200000X
TX34449122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program