Provider Demographics
NPI:1508251950
Name:LIM, JACQUIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACQUIE
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JACQUIE
Other - Middle Name:
Other - Last Name:TONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:140 ROBLES WAY
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-8039
Mailing Address - Country:US
Mailing Address - Phone:707-645-8400
Mailing Address - Fax:
Practice Address - Street 1:140 ROBLES WAY
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-8039
Practice Address - Country:US
Practice Address - Phone:707-645-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43085122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist