Organization
SPH BRIDGEPORT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIGONS SONG DDS (OWNER)
(646) 369-6918
Entity
Organization
Contact information
Practice address
161 BOSTON AVE, BRIDGEPORT, CT 06610-1662
(203) 873-0598
(203) 873-0602
Mailing address
161 BOSTON AVE, BRIDGEPORT, CT 06610-1662
(203) 873-0598
(203) 873-0602
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
09/09/2015
Last updated
09/09/2015
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