Provider Demographics
NPI:1164682514
Name:AHN, SONG (DDS, FAGD)
Entity Type:Individual
Prefix:DR
First Name:SONG
Middle Name:
Last Name:AHN
Suffix:
Gender:M
Credentials:DDS, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 N SHEPHERD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1931
Mailing Address - Country:US
Mailing Address - Phone:713-869-9973
Mailing Address - Fax:713-869-9943
Practice Address - Street 1:2707 N SHEPHERD DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1931
Practice Address - Country:US
Practice Address - Phone:713-869-9973
Practice Address - Fax:713-869-9943
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15120122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist