Provider Demographics
NPI:1326659087
Name:TRIPLE EIGHT DENTAL GROUP, PLLC
Entity Type:Organization
Organization Name:TRIPLE EIGHT DENTAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:623-340-6518
Mailing Address - Street 1:7910 W THOMAS RD STE 118
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85033-4830
Mailing Address - Country:US
Mailing Address - Phone:623-247-9300
Mailing Address - Fax:623-247-6505
Practice Address - Street 1:7910 W THOMAS RD STE 118
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-4830
Practice Address - Country:US
Practice Address - Phone:623-247-9300
Practice Address - Fax:623-247-6505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty