Provider Demographics
NPI:1356993422
Name:LIM, GILLIAN GAYLE (DDS)
Entity type:Individual
Prefix:DR
First Name:GILLIAN
Middle Name:GAYLE
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 1:15644 SE 54TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-5104
Mailing Address - Country:US
Mailing Address - Phone:206-954-3388
Mailing Address - Fax:
Practice Address - Street 1:3120 HOWE PL STE 200
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-5634
Practice Address - Country:US
Practice Address - Phone:360-927-2291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA609605121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice