Provider Demographics
NPI:1902940125
Name:LIMCHAYSENG, LUIS RAMON (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:RAMON
Last Name:LIMCHAYSENG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1701 NOVATO BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-3000
Mailing Address - Country:US
Mailing Address - Phone:415-892-8613
Mailing Address - Fax:415-892-0903
Practice Address - Street 1:1701 NOVATO BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-3000
Practice Address - Country:US
Practice Address - Phone:415-892-8613
Practice Address - Fax:415-892-0903
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA406581223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery