Provider Demographics
NPI:1144608787
Name:SONG, BELINDA YOUNG
Entity Type:Individual
Prefix:
First Name:BELINDA
Middle Name:YOUNG
Last Name:SONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4725 N OCONNOR RD
Mailing Address - Street 2:2047
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-9992
Mailing Address - Country:US
Mailing Address - Phone:469-789-7480
Mailing Address - Fax:
Practice Address - Street 1:7406 W STATE HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189-4166
Practice Address - Country:US
Practice Address - Phone:972-460-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-15
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31285122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist