Provider Demographics
NPI:1215945829
Name:LIMA, ELIZEU S (DMD)
Entity type:Individual
Prefix:DR
First Name:ELIZEU
Middle Name:S
Last Name:LIMA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:ELIZEU
Other - Middle Name:
Other - Last Name:LIMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:948 VETERANS MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-5025
Mailing Address - Country:US
Mailing Address - Phone:401-435-3104
Mailing Address - Fax:401-438-0665
Practice Address - Street 1:909 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5752
Practice Address - Country:US
Practice Address - Phone:401-272-1238
Practice Address - Fax:401-272-1468
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI25311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice