Provider Demographics
NPI:1629328869
Name:LIM, JACQUELINE Q (DDS)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:Q
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 1:164 E H ST
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-3231
Mailing Address - Country:US
Mailing Address - Phone:707-745-1994
Mailing Address - Fax:707-361-5699
Practice Address - Street 1:164 E H ST
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-3231
Practice Address - Country:US
Practice Address - Phone:707-745-1994
Practice Address - Fax:707-361-5699
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA615911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice