Provider Demographics
NPI:1497099725
Name:DR. SONG 8TH AND ALVARADO FAMILY DENTAL GROUP
Entity Type:Organization
Organization Name:DR. SONG 8TH AND ALVARADO FAMILY DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAE
Authorized Official - Middle Name:H
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-252-1700
Mailing Address - Street 1:824 S ALVARADO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-4010
Mailing Address - Country:US
Mailing Address - Phone:213-252-1700
Mailing Address - Fax:213-252-8108
Practice Address - Street 1:824 S ALVARADO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4010
Practice Address - Country:US
Practice Address - Phone:213-252-1700
Practice Address - Fax:213-252-8108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty