=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801195706
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 101 DENTAL & ORTHODONTICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2011
-----------------------------------------------------
Last Update Date | 05/01/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 E CORPORATE DR STE 120
-----------------------------------------------------
City | LEWISVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75067-6603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-459-5608
-----------------------------------------------------
Fax | 972-459-5638
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 E CORPORATE DR STE 120
-----------------------------------------------------
City | LEWISVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75067-6603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-459-5608
-----------------------------------------------------
Fax | 972-459-5638
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LIN CHANG
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 214-686-3139
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 23239
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------