Individual
SHI GUANG SONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1731 NW KINGS BLVD, CORVALLIS, OR 97330
(541) 705-2470
Mailing address
777 COMMERCIAL ST SE #510, SALEM, OR 97301
(267) 815-3792
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
012248
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/03/2023
Last updated
11/10/2025
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