Provider Demographics
NPI:1427392729
Name:SONG, EUNICE (DDS)
Entity Type:Individual
Prefix:DR
First Name:EUNICE
Middle Name:
Last Name:SONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9378 FORESTWOOD LN STE A
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4742
Mailing Address - Country:US
Mailing Address - Phone:703-659-1111
Mailing Address - Fax:703-659-1116
Practice Address - Street 1:9378 FORESTWOOD LN STE A
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4742
Practice Address - Country:US
Practice Address - Phone:703-659-1111
Practice Address - Fax:703-659-1116
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014137091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice