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General NPI Number Information
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NPI Number | 1700146966
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Entity Type | Organization
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Legal Business Name | E LINE ORTHODONTICS
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Dates
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Enumeration Date | 05/22/2012
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Last Update Date | 05/22/2012
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Provider Practice Location Address
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Address Line | 3044 OLD DENTON RD STE. 111-304
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City | CARROLLTON
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State | TX
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Zip | 75007-5016
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Country | US
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Telephone | 972-242-2040
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Fax | 972-446-0088
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Provider Business Mailing Address
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Address Line | 1017 E TRINITY MILLS RD 102
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City | CARROLLTON
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State | TX
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Zip | 75006-1438
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Country | US
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Telephone | 972-242-2040
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Fax | 972-446-0088
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Authorized Official
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Title or Position | OWNER
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Name | YOON H. CHANG
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Credential | D.D.S
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Telephone | 972-242-2040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 27128
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License Number State | TX
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