Provider Demographics
NPI:1316565823
Name:JUDY PEDRO-LIM
Entity Type:Organization
Organization Name:JUDY PEDRO-LIM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:PEDRO-LIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:651-452-4411
Mailing Address - Street 1:4640 SLATER RD STE 150
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-4045
Mailing Address - Country:US
Mailing Address - Phone:651-808-5252
Mailing Address - Fax:651-808-5252
Practice Address - Street 1:4640 SLATER RD STE 150
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-4045
Practice Address - Country:US
Practice Address - Phone:651-808-5252
Practice Address - Fax:651-808-5253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty