MEDICARE: MICHAEL S. SONG DDS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1336512342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL S. SONG DDS, PC

Provider Business Mailing Address
First Line	:	3975 FAIR RIDGE DR
Second Line	:	SUITE #301N
City	:	FAIRFAX
State	:	VA
Zip	:	22033-2911
Country	:	US
Telephone Number	:	703-385-5455
Fax Number	:

Provider Business Practice Location Address
First Line	:	3975 FAIR RIDGE DR
Second Line	:	SUITE #301N
City	:	FAIRFAX
State	:	VA
Zip	:	22033-2911
Country	:	US
Telephone Number	:	703-385-5455
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. MICHAEL S. SONG
Credential	:	DDS
Telephone Number	:	703-385-5455

Provider Enumeration Date	:	11/12/2015
Last Update Date	:	11/12/2015

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