Healthcare Provider Details

I. General information

NPI: 1922338474
Provider Name (Legal Business Name): MINSUNG SON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 NE 36TH AVE
OCALA FL
34470-4930
US

IV. Provider business mailing address

1220 NE 36TH AVE
OCALA FL
33470
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-4847
  • Fax:
Mailing address:
  • Phone: 352-281-1623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN18911
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: