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General NPI Number Information
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NPI Number | 1871741983
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Entity Type | Individual
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Provider Name | SEUNGHEE SONG
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Gender | Female
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 09/03/2008
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Provider Practice Location Address
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Address Line | 75 WAMSUTTA STREET APT # 308
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City | NEW BEDFORD
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State | MA
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Zip | 02740
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Country | US
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Telephone | 857-222-3741
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Fax |
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Provider Business Mailing Address
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Address Line | 145 FAUNCE CORNER RD STE C
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City | NORTH DARTMOUTH
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State | MA
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Zip | 02747-1263
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Country | US
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Telephone | 508-993-5900
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Fax | 508-993-5912
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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 | 22272
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License Number State | MA
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