Provider Demographics
NPI:1568594315
Name:LIM, GERALD (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74120 EL PASEO
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4120
Mailing Address - Country:US
Mailing Address - Phone:760-568-5488
Mailing Address - Fax:760-568-4668
Practice Address - Street 1:74120 EL PASEO
Practice Address - Street 2:SUITE 2
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4120
Practice Address - Country:US
Practice Address - Phone:760-568-5488
Practice Address - Fax:760-568-4668
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA387131223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics