Individual
KEVIN SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1795 MAIN ST STE 116, SPRINGFIELD, MA 01103-1078
(419) 439-0563
Mailing address
47 OAK ST UNIT B, WINDSOR LOCKS, CT 06096-1822
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN10000733
MA
Other
Enumeration date
04/04/2024
Last updated
06/12/2025
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