Provider Demographics
NPI:1962574590
Name:PEDRO-LIM, JUDY K (DMD, MDS)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:K
Last Name:PEDRO-LIM
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Gender:F
Credentials:DMD, MDS
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Mailing Address - Street 1:4640 SLATER RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-4043
Mailing Address - Country:US
Mailing Address - Phone:651-808-5252
Mailing Address - Fax:651-808-5253
Practice Address - Street 1:4640 SLATER RD
Practice Address - Street 2:SUITE 150
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-4043
Practice Address - Country:US
Practice Address - Phone:651-808-5252
Practice Address - Fax:651-808-5253
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MND106621223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN485517500Medicaid