Grace Song, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE61434179 Issued in WA

Practice address

3708 Bridgeport Way W
University Place, WA 98466-4419

Phone

(253) 215-1107

NPI assigned

Jun 28, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Washington Dental Corporation, PC

  • Dentist
  • Puyallup, WA
  • NPI 1295371128
  NPD (past)
• Washington Dental Corporation, PC

  • General Practice Dentistry
  • University Place, WA
  • NPI 1851833990
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692057600000",
    "number": "1396422796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3918 S KENYON ST UNIT C",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981184065",
            "telephone_number": "240-401-8383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3708 BRIDGEPORT WAY W",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984664419",
            "telephone_number": "253-215-1107"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "732 Shaw Rd Ste B",
            "address_purpose": "LOCATION",
            "city": "Puyallup",
            "state": "WA",
            "postal_code": "983725278",
            "country_code": "US",
            "telephone_number": "253-267-7112",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SONG",
        "first_name": "GRACE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-28",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE61434179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth Ray Smith Jr.
• Peggy Ann Smith, ARNP
• Rashanna Smith, LMP
• Carmilla Solomon, EDD LMHC
• James Neak Son, DDS
• Trinity Songha, LMFTA
• Mayra Crystal Sosa
• Sound Psychological Associates PS
• Soundcare, Inc.
• Soundview Eyecare Inc.

• General Practice Dentistry in University Place, WA
• Providers in University Place, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.