Provider Demographics
NPI:1003079468
Name:YONG C SONG DDS PA
Entity Type:Organization
Organization Name:YONG C SONG DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YONG
Authorized Official - Middle Name:CHOL
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-906-9797
Mailing Address - Street 1:3111 CROSS TIMBERS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2702
Mailing Address - Country:US
Mailing Address - Phone:972-906-9797
Mailing Address - Fax:972-874-1113
Practice Address - Street 1:3111 CROSS TIMBERS RD STE 100
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2702
Practice Address - Country:US
Practice Address - Phone:972-906-9797
Practice Address - Fax:214-350-7836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty