Healthcare Provider Details

I. General information

NPI: 1063483733
Provider Name (Legal Business Name): ZHENGSHI SONG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 S 11TH ST
TACOMA WA
98405-4020
US

IV. Provider business mailing address

480 CENTRAL AVE
JBPHH HI
96860-4908
US

V. Phone/Fax

Practice location:
  • Phone: 532-809-8402
  • Fax: 253-272-1952
Mailing address:
  • Phone: 757-953-2711
  • Fax: 757-953-0846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE00009411
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00009411
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDE00009411
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: