MEDICARE: NICOLE EUNHAE LIM DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	14226279-9926	UT

General Provider Information

NPI Number	:	1922982586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE EUNHAE LIM DDS

Provider Business Mailing Address
First Line	:	400 E PIKES PEAK AVE APT 440
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-4277
Country	:	US
Telephone Number	:	253-269-8618
Fax Number	:

Provider Business Practice Location Address
First Line	:	2280 HOGAN ST BLDG 1885
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4408
Country	:	US
Telephone Number	:	719-526-5400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2025
Last Update Date	:	08/05/2025

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