Provider Demographics
NPI:1992077523
Name:DE LIMA, FATIMA (DDS)
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:
Last Name:DE LIMA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:FATIMA
Other - Middle Name:
Other - Last Name:DEMELO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3190 31ST ST
Mailing Address - Street 2:#1A
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-2536
Mailing Address - Country:US
Mailing Address - Phone:718-721-1717
Mailing Address - Fax:
Practice Address - Street 1:3190 31ST ST
Practice Address - Street 2:#1A
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-2536
Practice Address - Country:US
Practice Address - Phone:718-721-1717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043544-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist