Provider Demographics
NPI:1265317796
Name:SONG, JANE J (DDS)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:J
Last Name:SONG
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 1:13105 WARRIOR DR
Mailing Address - Street 2:
Mailing Address - City:CRESAPTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21502-5616
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13105 WARRIOR DR
Practice Address - Street 2:
Practice Address - City:CRESAPTOWN
Practice Address - State:MD
Practice Address - Zip Code:21502-5616
Practice Address - Country:US
Practice Address - Phone:301-729-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD186831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice