Provider Demographics
NPI:1396052692
Name:CAGATAO, IRISH JEAN LIM (DDS)
Entity type:Individual
Prefix:DR
First Name:IRISH JEAN
Middle Name:LIM
Last Name:CAGATAO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:IRISH JEAN
Other - Middle Name:DE GUZMAN
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2903 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-3412
Mailing Address - Country:US
Mailing Address - Phone:818-236-3848
Mailing Address - Fax:818-236-3848
Practice Address - Street 1:2903 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-3412
Practice Address - Country:US
Practice Address - Phone:818-236-3848
Practice Address - Fax:818-236-3848
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA564691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice