Provider Demographics
NPI:1568988186
Name:SONG, STEVE (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVE
Middle Name:
Last Name:SONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8476 SIMMOND ST
Mailing Address - Street 2:
Mailing Address - City:FORT GEORGE G MEADE
Mailing Address - State:MD
Mailing Address - Zip Code:20755-7083
Mailing Address - Country:US
Mailing Address - Phone:301-677-6122
Mailing Address - Fax:
Practice Address - Street 1:9225 DOERR RD BLDG 1229
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-2204
Practice Address - Country:US
Practice Address - Phone:571-231-6054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022187122300000X, 171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No122300000XDental ProvidersDentistGroup - Single Specialty