Most Relevant Information
Provider Data
| NPI Number: | 1003238650 |
| Provider Name: | ISSE SONG |
| Entity Type: | Individual |
| Taxonomy Code: | 1223G0001X |
| Specialty: | Dentist |
| License Number: | DN11703 |
Most Important Dates
| Enumeration Date: | 01/16/2014 |
| Last Updated: | 01/16/2014 |
Provider Practice Location
12554 S JOHN YOUNG PKWY
SUITE104
ORLANDO
FL
328374004
Practice Location Phone/Fax
| Phone: | 4078881088 |
| Fax: | 4078881089 |
Provider Mailing Location
12554 S JOHN YOUNG PKWY
SUITE104
ORLANDO
FL
328374004
Provider Mailing Phone/Fax
| Phone: | 4078881088 |
| Fax: | 4078881089 |