=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407004633
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRACESNSMILES JILLIAN LIM DMD MS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2008
-----------------------------------------------------
Last Update Date | 08/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 432 E 116TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10029-1620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-831-8414
-----------------------------------------------------
Fax | 212-831-8475
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 432 E 116TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10029-1620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-831-8414
-----------------------------------------------------
Fax | 212-831-8475
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JILLIAN LIM
-----------------------------------------------------
Credential | D.M.D., M.S.
-----------------------------------------------------
Telephone | 212-831-8414
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 0444481
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------