Organization
LONG RIDGE DENTAL LLC
Active
Other names
Long Ridge Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIGON SONG DDS (OWNER)
(646) 369-6918
Entity
Organization
Contact information
Practice address
3741 MAIN ST, BRIDGEPORT, CT 06606-3609
(475) 282-4912
(475) 282-4915
Mailing address
3741 MAIN ST, BRIDGEPORT, CT 06606-3609
(475) 282-4912
(475) 282-4915
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
06/26/2014
Last updated
03/02/2015
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