Provider Demographics
NPI:1326238353
Name:LIM, WALTER CO (DDM, DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:CO
Last Name:LIM
Suffix:
Gender:M
Credentials:DDM, DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 W OUTER DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-3580
Mailing Address - Country:US
Mailing Address - Phone:313-494-6782
Mailing Address - Fax:313-494-6781
Practice Address - Street 1:8200 W OUTER DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-3580
Practice Address - Country:US
Practice Address - Phone:313-494-6782
Practice Address - Fax:313-494-6781
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018540122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist