Provider Demographics
NPI:1437245230
Name:CHANG, DAVID JONATHAN (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JONATHAN
Last Name:CHANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 SHAVER ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77502-2027
Mailing Address - Country:US
Mailing Address - Phone:713-589-1888
Mailing Address - Fax:713-589-1998
Practice Address - Street 1:1701 SHAVER ST STE 100
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77502-2027
Practice Address - Country:US
Practice Address - Phone:713-589-1888
Practice Address - Fax:713-589-1998
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB2133701OtherDELTA DENTAL CHIPS
TX1580433-08Medicaid
TX1580433-09Medicaid
TX1580433-07Medicaid