MEDICARE: DR. MARK LIM DMD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	34407	TX

General Provider Information

NPI Number	:	1871022269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK LIM DMD

Provider Business Mailing Address
First Line	:	4421 LONG PRAIRIE RD STE 100
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-1752
Country	:	US
Telephone Number	:	972-534-5663
Fax Number	:

Provider Business Practice Location Address
First Line	:	4421 LONG PRAIRIE RD STE 100
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-1752
Country	:	US
Telephone Number	:	972-534-5663
Fax Number	:

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

Provider Enumeration Date	:	06/08/2017
Last Update Date	:	07/06/2023

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Directions to “ DR. MARK LIM DMD” Practice Location

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