Provider Demographics
NPI:1376702167
Name:LIM, ALICE TALENS (DDS)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:TALENS
Last Name:LIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1559 E AMAR RD
Mailing Address - Street 2:SUITE V
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-1679
Mailing Address - Country:US
Mailing Address - Phone:626-913-3341
Mailing Address - Fax:626-913-3601
Practice Address - Street 1:1559 E AMAR RD
Practice Address - Street 2:SUITE V
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-1679
Practice Address - Country:US
Practice Address - Phone:626-913-3341
Practice Address - Fax:626-913-3601
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA569691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice