Provider Demographics
NPI:1578600276
Name:SONNY LIM D.M.D. INC.
Entity Type:Organization
Organization Name:SONNY LIM D.M.D. INC.
Other - Org Name:SPRINGLAKE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SONNY
Authorized Official - Middle Name:SY
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:1530-406-1730
Mailing Address - Street 1:1837 E GIBSON RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95776-5163
Mailing Address - Country:US
Mailing Address - Phone:530-406-1730
Mailing Address - Fax:530-406-0108
Practice Address - Street 1:1837 E GIBSON RD
Practice Address - Street 2:SUITE D
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95776-5163
Practice Address - Country:US
Practice Address - Phone:530-406-1730
Practice Address - Fax:530-406-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA433631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty