Provider Demographics
NPI:1982279386
Name:LIMA, ANTHONY RYAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:RYAN
Last Name:LIMA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8211 ROUGHRIDER DR
Mailing Address - Street 2:
Mailing Address - City:WINDCREST
Mailing Address - State:TX
Mailing Address - Zip Code:78239-2446
Mailing Address - Country:US
Mailing Address - Phone:210-657-0101
Mailing Address - Fax:
Practice Address - Street 1:8211 ROUGHRIDER DR
Practice Address - Street 2:
Practice Address - City:WINDCREST
Practice Address - State:TX
Practice Address - Zip Code:78239-2446
Practice Address - Country:US
Practice Address - Phone:210-657-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX38303122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program