Healthcare Provider Details

I. General information

NPI: 1407782725
Provider Name (Legal Business Name): BRENDON TAESUP SONG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 SERGEANT JON STILES DR
HIGHLANDS RANCH CO
80129
US

IV. Provider business mailing address

1165 SERGEANT JON STILES DR
HIGHLANDS RANCH CO
80129
US

V. Phone/Fax

Practice location:
  • Phone: 303-791-3209
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN.00206637
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: