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General NPI Number Information
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NPI Number | 1790113678
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Entity Type | Individual
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Provider Name | SEUNG SONG D.D.S
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Gender | Male
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Dates
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Enumeration Date | 10/31/2013
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Last Update Date | 10/31/2013
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Provider Practice Location Address
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Address Line | 3200 ANDREWS HWY STE 400
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City | MIDLAND
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State | TX
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Zip | 79701-3950
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Country | US
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Telephone | 432-218-7926
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Fax |
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Provider Business Mailing Address
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Address Line | 245 N GRAMERCY PL
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City | LOS ANGELES
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State | CA
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Zip | 90004-4021
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Country | US
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Telephone | 714-309-2320
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 29544
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License Number State | TX
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