Provider Demographics
NPI:1003039298
Name:LIM, BELLA TALLO
Entity Type:Individual
Prefix:DR
First Name:BELLA
Middle Name:TALLO
Last Name:LIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7455 EL CAMINO REAL
Mailing Address - Street 2:SUITE C
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-2922
Mailing Address - Country:US
Mailing Address - Phone:650-994-4561
Mailing Address - Fax:650-994-4562
Practice Address - Street 1:7455 EL CAMINO REAL
Practice Address - Street 2:SUITE C
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-2922
Practice Address - Country:US
Practice Address - Phone:650-994-4561
Practice Address - Fax:650-994-4562
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA385541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice