Provider Demographics
NPI:1336472166
Name:LIM, JOANNE (DMD)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 HOLLAND ST
Mailing Address - Street 2:ALJHC
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14605-2131
Mailing Address - Country:US
Mailing Address - Phone:585-423-5800
Mailing Address - Fax:585-423-2890
Practice Address - Street 1:480 GENESEE ST
Practice Address - Street 2:JORDAN HEALTH AT WOODWARD
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-3634
Practice Address - Country:US
Practice Address - Phone:585-436-3040
Practice Address - Fax:585-328-3812
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
NY0564211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03423796Medicaid