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General NPI Number Information
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NPI Number | 1316565823
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Entity Type | Organization
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Legal Business Name | JUDY PEDRO-LIM
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Dates
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Enumeration Date | 07/10/2020
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Last Update Date | 07/10/2020
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Provider Practice Location Address
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Address Line | 4640 SLATER RD STE 150
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City | EAGAN
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State | MN
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Zip | 55122-4045
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Country | US
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Telephone | 651-808-5252
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Fax | 651-808-5253
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Provider Business Mailing Address
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Address Line | 4640 SLATER RD STE 150
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City | EAGAN
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State | MN
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Zip | 55122-4045
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Country | US
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Telephone | 651-808-5252
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Fax | 651-808-5252
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | JUDY K PEDRO-LIM
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Credential | DMD
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Telephone | 651-452-4411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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