MEDICARE: LEAH SONG

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	1223G0001X	General Practice Dentistry	DN1857214	MA

General Provider Information

NPI Number	:	1518316736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH SONG

Provider Business Mailing Address
First Line	:	59 BEECH ST
Second Line	:
City	:	WEST ROXBURY
State	:	MA
Zip	:	02132-2016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	FORT HOOD
Second Line	:
City	:	APO
State	:	AA
Zip	:	76544-9996
Country	:	US
Telephone Number	:	781-354-5689
Fax Number	:

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

Provider Enumeration Date	:	06/08/2016
Last Update Date	:	06/18/2024

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Directions to “ LEAH SONG ” Practice Location

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