Provider Demographics
NPI:1619235371
Name:LIM, VICTOR JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:JAMES
Last Name:LIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 AGORA DR STE 2B
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-6859
Mailing Address - Country:US
Mailing Address - Phone:909-579-9718
Mailing Address - Fax:
Practice Address - Street 1:1201 AGORA DR STE 2B
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-6859
Practice Address - Country:US
Practice Address - Phone:909-579-9718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD152681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice