Healthcare Provider Details

I. General information

NPI: 1407004633
Provider Name (Legal Business Name): BRACESNSMILES JILLIAN LIM DMD MS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2008
Last Update Date: 08/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 E 116TH ST
NEW YORK NY
10029-1620
US

IV. Provider business mailing address

432 E 116TH ST
NEW YORK NY
10029-1620
US

V. Phone/Fax

Practice location:
  • Phone: 212-831-8414
  • Fax: 212-831-8475
Mailing address:
  • Phone: 212-831-8414
  • Fax: 212-831-8475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0444481
License Number StateNY

VIII. Authorized Official

Name: DR. JILLIAN LIM
Title or Position: PRESIDENT
Credential: D.M.D., M.S.
Phone: 212-831-8414