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General NPI Number Information
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NPI Number | 1245258748
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Entity Type | Individual
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Provider Name | JENNIFER K LIM DDS
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Gender | Female
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 08/05/2011
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Provider Practice Location Address
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Address Line | 410 N MALACATE ST BLDG B DESERT SENITA DENTAL CENTER
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City | AJO
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State | AZ
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Zip | 85321-2254
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Country | US
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Telephone | 520-387-4500
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Fax | 520-387-3509
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Provider Business Mailing Address
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Address Line | 410 MALACATE ST, BLDG B
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City | AJO
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State | AZ
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Zip | 85321
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Country | US
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Telephone | 520-387-4500
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Fax | 520-387-3509
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D5942
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License Number State | AZ
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