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General NPI Number Information
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NPI Number | 1659319655
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Entity Type | Organization
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Legal Business Name | DR. ISSE SONG DENTAL OFFICE
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12554 S JOHN YOUNG PKWY #104
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City | ORLANDO
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State | FL
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Zip | 32837-4004
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Country | US
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Telephone | 407-888-1088
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Fax | 407-888-1889
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Provider Business Mailing Address
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Address Line | 12554 S JOHN YOUNG PKWY #104
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City | ORLANDO
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State | FL
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Zip | 32837-4004
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Country | US
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Telephone | 407-888-1088
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Fax | 407-888-1889
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Authorized Official
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Title or Position | D.M.D., PH. D.,FAGD/ DOCTOR
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Name | ISSE SONG
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Credential | D.M.D
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Telephone | 407-888-1088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN11703
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License Number State | FL
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