Provider Demographics
NPI:1821665639
Name:SONG, SILVIA EUNYUONG (DMD)
Entity Type:Individual
Prefix:DR
First Name:SILVIA
Middle Name:EUNYUONG
Last Name:SONG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 PALMER GLEN CT
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-2642
Mailing Address - Country:US
Mailing Address - Phone:267-393-2656
Mailing Address - Fax:
Practice Address - Street 1:10680 MAIN ST STE 150
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3811
Practice Address - Country:US
Practice Address - Phone:703-385-4569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401417445122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist