Provider Demographics
NPI:1689191116
Name:LIM, DANIEL SEUNG (DMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:SEUNG
Last Name:LIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 OLD DENTON RD APT 1202
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-2318
Mailing Address - Country:US
Mailing Address - Phone:201-618-2776
Mailing Address - Fax:
Practice Address - Street 1:190 E STACY RD
Practice Address - Street 2:BLDG 300 STE 314
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-8738
Practice Address - Country:US
Practice Address - Phone:972-678-1277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice