Provider Demographics
NPI:1720776032
Name:HONG, SONG-HENG (DMD)
Entity Type:Individual
Prefix:DR
First Name:SONG-HENG
Middle Name:
Last Name:HONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10210 ROCKY ROAD PL
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-3721
Mailing Address - Country:US
Mailing Address - Phone:240-470-2264
Mailing Address - Fax:
Practice Address - Street 1:1087 N MILITARY HWY
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-0028
Practice Address - Country:US
Practice Address - Phone:757-451-7042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014184571223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program