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Organization
LONG RIDGE DENTAL LLC
Active
Organization
LONG RIDGE DENTAL LLC
Active
Other names
Long Ridge Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIGON SONG DDS (OWNER)
(646) 369-6918
Entity
Organization
Contact information
Practice address
3741 MAIN ST, BRIDGEPORT, CT 06606-3609
(475) 282-4912
(475) 282-4915
Mailing address
3741 MAIN ST, BRIDGEPORT, CT 06606-3609
(475) 282-4912
(475) 282-4915
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
06/26/2014
Last updated
03/02/2015
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