Provider Demographics
NPI:1538698279
Name:SON, MINKYEONG (DDS)
Entity Type:Individual
Prefix:
First Name:MINKYEONG
Middle Name:
Last Name:SON
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 1:4003 BARNACLE CT
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-3232
Mailing Address - Country:US
Mailing Address - Phone:804-691-6178
Mailing Address - Fax:
Practice Address - Street 1:410 MINERAL ST
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-3716
Practice Address - Country:US
Practice Address - Phone:434-572-4928
Practice Address - Fax:434-575-0302
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014156431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice