Provider Demographics
NPI:1164439345
Name:SONG, BAIZHENG (DMD)
Entity Type:Individual
Prefix:DR
First Name:BAIZHENG
Middle Name:
Last Name:SONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1842 BEACON ST STE 306
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-1922
Mailing Address - Country:US
Mailing Address - Phone:617-264-9966
Mailing Address - Fax:617-730-8058
Practice Address - Street 1:1842 BEACON ST STE 306
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-1922
Practice Address - Country:US
Practice Address - Phone:617-264-9966
Practice Address - Fax:617-730-8058
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA186101223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery