Provider Demographics
NPI:1730463662
Name:LIM, DOUGLAS W (DMD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:W
Last Name:LIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 WEST 19TH ST.
Mailing Address - Street 2:SUITE B
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-6148
Mailing Address - Country:US
Mailing Address - Phone:949-650-8186
Mailing Address - Fax:
Practice Address - Street 1:728 WEST 19TH ST.
Practice Address - Street 2:SUITE B
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-6148
Practice Address - Country:US
Practice Address - Phone:949-650-8186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice