Provider Demographics
NPI:1558561308
Name:LIM, PHANITH LEANG (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHANITH
Middle Name:LEANG
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 1:271 PALMDALE DR APT 3
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4013
Mailing Address - Country:US
Mailing Address - Phone:571-276-5045
Mailing Address - Fax:
Practice Address - Street 1:9290 BOSTON STATE RD
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:NY
Practice Address - Zip Code:14025-9604
Practice Address - Country:US
Practice Address - Phone:716-941-5352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053216-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice