Provider Demographics
NPI:1154583672
Name:LIM, VERA MONICA (DDS)
Entity type:Individual
Prefix:
First Name:VERA
Middle Name:MONICA
Last Name:LIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 WINDSOR MANOR CT
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-5992
Mailing Address - Country:US
Mailing Address - Phone:404-805-2405
Mailing Address - Fax:770-476-4818
Practice Address - Street 1:400 CLEVELAND AVE SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-8144
Practice Address - Country:US
Practice Address - Phone:404-761-8455
Practice Address - Fax:404-761-2181
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019880122300000X
GADN013849122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist