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Organization
TCID PLLC
Active
Organization
TCID PLLC
Active
Other names
Carrollton Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. INSOO SONG (DENTIST)
(972) 492-0002
Entity
Organization
Contact information
Practice address
1628 W HEBRON PKWY STE 108, CARROLLTON, TX 75010-6311
(972) 492-0002
Mailing address
1628 W HEBRON PKWY STE 108, CARROLLTON, TX 75010-6311
(972) 492-0002
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
35046
STATE LICENSE
TX
Enumeration date
02/05/2020
Last updated
02/05/2020
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