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General NPI Number Information
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NPI Number | 1275155665
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Entity Type | Individual
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Provider Name | JOANNA SONG
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Gender | Female
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Dates
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Enumeration Date | 05/08/2020
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Last Update Date | 05/08/2020
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Provider Practice Location Address
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Address Line | 2540 FM 2920 RD STE H
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City | SPRING
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State | TX
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Zip | 77388-3672
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Country | US
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Telephone | 281-937-2540
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Fax |
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Provider Business Mailing Address
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Address Line | 18715 S COLONY SHORE DR
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City | CYPRESS
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State | TX
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Zip | 77433-2485
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Country | US
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Telephone | 617-833-7253
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 35952
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License Number State | TX
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