Provider Demographics
NPI:1639260821
Name:LIM, PETER GENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:GENE
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 1:4050 WAKE FOREST RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6860
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:27609-6860
Practice Address - Country:US
Practice Address - Phone:919-954-2273
Practice Address - Fax:919-521-5499
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013052122300000X
NC81161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8116OtherNC DENTAL LICENSE
GADN013052OtherGA DENTAL LICENSE
SC4070OtherSC DENTAL LICENSE
VA040-141-04-24OtherVA DENTAL LICENSE
BL9087049OtherFEDERAL DEA NUMBER