Provider Demographics
NPI:1336512342
Name:MICHAEL S. SONG DDS, PC
Entity Type:Organization
Organization Name:MICHAEL S. SONG DDS, PC
Other - Org Name:FC DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-385-5455
Mailing Address - Street 1:3975 FAIR RIDGE DR
Mailing Address - Street 2:SUITE #301N
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2911
Mailing Address - Country:US
Mailing Address - Phone:703-385-5455
Mailing Address - Fax:
Practice Address - Street 1:3975 FAIR RIDGE DR
Practice Address - Street 2:SUITE #301N
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2911
Practice Address - Country:US
Practice Address - Phone:703-385-5455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POTOMAC VALLEY DENTAL CARE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty