1679654628 NPI number — MARK M. LIMA, D.D.S.

Table of content: (NPI 1679654628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679654628 NPI number — MARK M. LIMA, D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARK M. LIMA, D.D.S.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LONDON DENTAL CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679654628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
116 E HIGH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONDON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43140-1229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-852-5771
Provider Business Mailing Address Fax Number:
740-852-6850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 E HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONDON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43140-1229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-852-5771
Provider Business Practice Location Address Fax Number:
740-852-6850
Provider Enumeration Date:
10/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LIMA
Authorized Official First Name:
MARK
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER, PRESIDENT
Authorized Official Telephone Number:
740-852-5771

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  17376 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QD0000X , with the licence number: 22035 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)