Individual
ANGELICA SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
4171 CRESCENT DR STE 102, SAINT LOUIS, MO 63129-3645
(314) 742-8038
Mailing address
5712 OAKLAND AVE, SAINT LOUIS, MO 63110-1318
(314) 742-8038
Taxonomy
Speciality
Code
Description
License number
State
202C00000X
Independent Medical Examiner Physician
Primary
2025021915
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/05/2025
Last updated
07/16/2025
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