Provider Demographics
NPI:1871741983
Name:SONG, SEUNGHEE
Entity type:Individual
Prefix:
First Name:SEUNGHEE
Middle Name:
Last Name:SONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 FAUNCE CORNER RD STE C
Mailing Address - Street 2:
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1263
Mailing Address - Country:US
Mailing Address - Phone:508-993-5900
Mailing Address - Fax:508-993-5912
Practice Address - Street 1:75 WAMSUTTA STREET
Practice Address - Street 2:APT # 308
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740
Practice Address - Country:US
Practice Address - Phone:857-222-3741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice