Individual
JUSTIN SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
11585 US RT 14, WOODSTOCK, IL 60098
(815) 269-4681
Mailing address
1175 CENTRAL PARK DR UNIT 206, CRYSTAL LAKE, IL 60014-8236
(812) 361-6107
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.033660
IL
Other
Enumeration date
06/24/2022
Last updated
06/24/2022
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