Healthcare Provider Details

I. General information

NPI: 1720943624
Provider Name (Legal Business Name): JORGE LUIS LIMA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 S SHORE DR
MIRAMAR BEACH FL
32550-5822
US

IV. Provider business mailing address

30 LANYARD LN UNIT 1100
SANTA ROSA BEACH FL
32459-6017
US

V. Phone/Fax

Practice location:
  • Phone: 850-290-4971
  • Fax:
Mailing address:
  • Phone: 786-656-5135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN31874
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: