Provider Demographics
NPI:1114334208
Name:LIM, DONG UN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONG
Middle Name:UN
Last Name:LIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 E BELT LINE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2215
Mailing Address - Country:US
Mailing Address - Phone:469-736-0111
Mailing Address - Fax:
Practice Address - Street 1:824 E BELT LINE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2215
Practice Address - Country:US
Practice Address - Phone:469-736-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX301561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice