Provider Demographics
NPI:1063483733
Name:SONG, ZHENGSHI (DDS)
Entity type:Individual
Prefix:DR
First Name:ZHENGSHI
Middle Name:
Last Name:SONG
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:JBPHH
Mailing Address - State:HI
Mailing Address - Zip Code:96860-4908
Mailing Address - Country:US
Mailing Address - Phone:757-953-2711
Mailing Address - Fax:757-953-0846
Practice Address - Street 1:1215 S 11TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4020
Practice Address - Country:US
Practice Address - Phone:532-809-8402
Practice Address - Fax:253-272-1952
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00009411122300000X, 1223G0001X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice