Provider Demographics
NPI:1841290020
Name:TAN, ROSE MARIE LIM (DDS)
Entity type:Individual
Prefix:DR
First Name:ROSE MARIE
Middle Name:LIM
Last Name:TAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ROSE MARIE
Other - Middle Name:LIM
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:212 E COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1945
Mailing Address - Country:US
Mailing Address - Phone:714-525-4850
Mailing Address - Fax:714-525-3760
Practice Address - Street 1:212 E COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1945
Practice Address - Country:US
Practice Address - Phone:714-525-4850
Practice Address - Fax:714-525-3760
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice