Provider Demographics
NPI:1720125750
Name:LIMA, LUCELIA D (DDS)
Entity Type:Individual
Prefix:
First Name:LUCELIA
Middle Name:D
Last Name:LIMA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 STUART RD NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-4918
Mailing Address - Country:US
Mailing Address - Phone:423-559-0887
Mailing Address - Fax:423-559-1058
Practice Address - Street 1:430 STUART RD NE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4918
Practice Address - Country:US
Practice Address - Phone:423-559-0887
Practice Address - Fax:423-559-1058
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS8607122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist