Individual
LIANSHENG SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
263 FARMINGTON AVE, DIVISION OF OMS L-7073, MC1720, FARMINGTON, CT 06030-1720
(860) 679-2583
(860) 679-1702
Mailing address
263 FARMINGTON AVE, DIVISION OF OMS L-7073, MC1720, FARMINGTON, CT 06030-1720
(860) 679-2583
(860) 679-1702
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
010234
CT
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
010234
CT
Other
Enumeration date
11/29/2006
Last updated
03/07/2013
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