Provider Demographics
NPI:1518213297
Name:LIM, SOMI MICHELLE (DDS)
Entity Type:Individual
Prefix:
First Name:SOMI
Middle Name:MICHELLE
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 1:5870 LEATHER DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-7519
Mailing Address - Country:US
Mailing Address - Phone:719-210-4097
Mailing Address - Fax:
Practice Address - Street 1:2810 S ACADEMY BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80916-3055
Practice Address - Country:US
Practice Address - Phone:719-418-2456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2018041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice