Basic Information
| Provider Information | |||||||||
| NPI: | 1568907426 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WANG | ||||||||
| FirstName: | ELIJAH | ||||||||
| MiddleName: | CHANG | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.S., D.D.S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2725 RASPBERRY CT | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750742050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083869401 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5129 N GARLAND AVE | ||||||||
| Address2: | |||||||||
| City: | GARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750402725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722765191 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2017 | ||||||||
| LastUpdateDate: | 01/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | DEN.00203033 | CO | N | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics | 1223X0400X | 34593 | TX | Y | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.