Provider Demographics
NPI:1558319582
Name:SONG, YONG U (DDS)
Entity Type:Individual
Prefix:DR
First Name:YONG
Middle Name:U
Last Name:SONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-1812
Mailing Address - Country:US
Mailing Address - Phone:201-227-0040
Mailing Address - Fax:201-227-0034
Practice Address - Street 1:16 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-1812
Practice Address - Country:US
Practice Address - Phone:201-227-0040
Practice Address - Fax:201-227-0034
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022070001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice