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General NPI Number Information
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NPI Number | 1639260821
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Entity Type | Individual
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Provider Name | PETER GENE LIM D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 4050 WAKE FOREST RD
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City | RALEIGH
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State | NC
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Zip | 27609-6860
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Country | US
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Telephone | 919-954-2273
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Fax | 919-521-5499
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Provider Business Mailing Address
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Address Line | 4050 WAKE FOREST RD
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City | RALEIGH
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State | NC
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Zip | 27609-6860
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Country | US
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Telephone | 919-954-2273
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Fax | 919-521-5499
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN013052
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8116
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License Number State | NC
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