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General NPI Number Information
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NPI Number | 1497382303
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Entity Type | Organization
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Legal Business Name | PUEBLO FAMILY DENTISTRY PLLC
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Dates
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Enumeration Date | 03/23/2020
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Last Update Date | 03/23/2020
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Provider Practice Location Address
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Address Line | 701 N GRAND AVENUE SUITE B
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City | PUEBLO
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State | CO
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Zip | 81003
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Country | US
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Telephone | 719-210-4097
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Fax |
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Provider Business Mailing Address
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Address Line | 2810 S. ACADEMY BLVD. SUITE# 130
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City | COLORADO SPRINGS
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State | CO
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Zip | 80916
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Country | US
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Telephone | 719-418-2456
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Fax | 719-247-8925
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. SOMI M LIM
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Credential | DDS
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Telephone | 719-418-2456
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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 |
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License Number State |
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