Healthcare Provider Details

I. General information

NPI: 1427219245
Provider Name (Legal Business Name): RATHANA LIM MD, DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RAY LIM MD, DDS

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 FLORIDA AVE 5TH FLOOR - DEPT OF ORAL & MAXILLOFACIAL SURGERY
NEW ORLEANS LA
70119-2715
US

IV. Provider business mailing address

230 20TH ST
NEW ORLEANS LA
70124-1236
US

V. Phone/Fax

Practice location:
  • Phone: 504-941-8216
  • Fax:
Mailing address:
  • Phone: 213-422-0928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number56788
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6089
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: