Provider Demographics
NPI:1366578858
Name:SONG, TERRY (DDS)
Entity type:Individual
Prefix:DR
First Name:TERRY
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 1:10643 PROFESSIONAL CIR # 102
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-5851
Mailing Address - Country:US
Mailing Address - Phone:775-737-4035
Mailing Address - Fax:775-737-4036
Practice Address - Street 1:10643 PROFESSIONAL CIR # 102
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5851
Practice Address - Country:US
Practice Address - Phone:775-737-4035
Practice Address - Fax:775-737-4036
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5589122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist