Provider Demographics
NPI:1811454010
Name:SONG, A RAN (RDH)
Entity type:Individual
Prefix:
First Name:A
Middle Name:RAN
Last Name:SONG
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10742 ENFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21163-1416
Mailing Address - Country:US
Mailing Address - Phone:443-980-6521
Mailing Address - Fax:
Practice Address - Street 1:200 GIRARD ST STE 212B
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-3490
Practice Address - Country:US
Practice Address - Phone:301-840-8339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-23
Last Update Date:2019-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD7680124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist