MEDICARE: GARY CHANG DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	34562	TX

General Provider Information

NPI Number	:	1699263186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY CHANG DMD

Provider Business Mailing Address
First Line	:	1615 WHEELER ST UNIT E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-4989
Country	:	US
Telephone Number	:	361-648-5826
Fax Number	:

Provider Business Practice Location Address
First Line	:	6715 BISSONNET ST # 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-6129
Country	:	US
Telephone Number	:	832-932-9673
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2018
Last Update Date	:	11/19/2021

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