Provider Demographics
NPI:1164599569
Name:SONG, LIANSHENG (DDS)
Entity Type:Individual
Prefix:
First Name:LIANSHENG
Middle Name:
Last Name:SONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:DIVISION OF OMS L-7073, MC1720
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-1720
Mailing Address - Country:US
Mailing Address - Phone:860-679-2583
Mailing Address - Fax:860-679-1702
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:DIVISION OF OMS L-7073, MC1720
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-1720
Practice Address - Country:US
Practice Address - Phone:860-679-2583
Practice Address - Fax:860-679-1702
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2013-03-07
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Provider Licenses
StateLicense IDTaxonomies
CT010234204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery