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General NPI Number Information
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NPI Number | 1114842986
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Entity Type | Organization
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Legal Business Name | SONG DENTAL GROUP
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Dates
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Enumeration Date | 08/11/2026
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Last Update Date | 08/11/2026
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Provider Practice Location Address
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Address Line | 175 NEWARK AVE UNIT 3A-1
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City | JERSEY CITY
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State | NJ
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Zip | 07302-2859
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Country | US
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Telephone | 626-848-4471
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Fax |
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Provider Business Mailing Address
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Address Line | 401 WASHINGTON BLVD APT 2101
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City | JERSEY CITY
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State | NJ
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Zip | 07310-2227
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. RICHARD SONG
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Credential | DDS
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Telephone | 626-848-4471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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