Provider Demographics
NPI:1801982210
Name:LIM, MARIAM JAAFAR (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:JAAFAR
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 1:1130 VESTER AVE STE F
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-7300
Mailing Address - Country:US
Mailing Address - Phone:937-390-1177
Mailing Address - Fax:
Practice Address - Street 1:1130 VESTER AVE STE F
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-7300
Practice Address - Country:US
Practice Address - Phone:937-390-1177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH187271223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics