Provider Demographics
NPI:1487742763
Name:LIM, JOHN THEODORE (DDS)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:THEODORE
Last Name:LIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:533 WASHINGTON NE
Mailing Address - Street 2:JOHN T LIM
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108
Mailing Address - Country:US
Mailing Address - Phone:505-268-9047
Mailing Address - Fax:505-262-0808
Practice Address - Street 1:533 WASHINGTON NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108
Practice Address - Country:US
Practice Address - Phone:505-268-9047
Practice Address - Fax:505-262-0808
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD1242122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist