Provider Demographics
NPI:1194275826
Name:JANG, MIRA (DDS)
Entity type:Individual
Prefix:
First Name:MIRA
Middle Name:
Last Name:JANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N KIMBALL AVE
Mailing Address - Street 2:STE 221 #1067
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6660
Mailing Address - Country:US
Mailing Address - Phone:214-909-2312
Mailing Address - Fax:
Practice Address - Street 1:3219 N MACARTHUR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-8805
Practice Address - Country:US
Practice Address - Phone:972-252-7569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX324721223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry