Organization
DISCOUNT DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUN SONG DDS,MMSC (DENTIST)
(718) 460-6868
Entity
Organization
Contact information
Practice address
14210 ROOSEVELT AVE # 8, FLUSHING, NY 11354-6046
(718) 460-6868
(718) 460-2112
Mailing address
14210 ROOSEVELT AVE # 8, FLUSHING, NY 11354-6046
(718) 460-6868
(718) 460-2112
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
057616
NY
122300000X
Dentist
057991
NY
1223P0300X
Periodontics
Primary
048211
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02455109
—
NY
Enumeration date
03/25/2016
Last updated
03/25/2016
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