Individual
DR. TONY YOUNGCHANG SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
7223 MISSISSIPPI AVE, FORT POLK, LA 71459
(726) 780-2175
Mailing address
7223 MISSISSIPPI AVE, FORT POLK, LA 71459
(726) 780-2175
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
14065149-9926
UT
Other
Enumeration date
07/24/2024
Last updated
09/30/2025
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