Provider Demographics
NPI:1073524765
Name:LIM, KIMBERLY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:M
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 1:3104 CREEKSIDE VILLAGE DR NW
Mailing Address - Street 2:SUITE 301
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-2324
Mailing Address - Country:US
Mailing Address - Phone:770-974-8211
Mailing Address - Fax:
Practice Address - Street 1:3104 CREEKSIDE VILLAGE DR NW
Practice Address - Street 2:SUITE 301
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-2324
Practice Address - Country:US
Practice Address - Phone:770-974-8211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0125861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice