Provider Demographics
NPI:1598093205
Name:DR. PETER G. LIM, D.D.S., P.L.L.C.
Entity Type:Organization
Organization Name:DR. PETER G. LIM, D.D.S., P.L.L.C.
Other - Org Name:COMPREHENSIVE DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-954-2273
Mailing Address - Street 1:4050 WAKE FOREST RD
Mailing Address - Street 2:P.O. BOX 18008
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27619-8008
Mailing Address - Country:US
Mailing Address - Phone:919-954-2273
Mailing Address - Fax:919-521-5499
Practice Address - Street 1:4050 WAKE FOREST RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:29609-6860
Practice Address - Country:US
Practice Address - Phone:919-954-2273
Practice Address - Fax:919-521-5499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC-8116122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907764Medicaid
1639260821OtherINDIVIDUAL NPI NUMBER