MEDICARE: FATIMA DE LIMA D.D.S.

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	122300000X	Dentist	043544-1	NY

General Provider Information

NPI Number	:	1992077523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FATIMA DE LIMA D.D.S.

Provider Business Mailing Address
First Line	:	3190 31ST ST
Second Line	:	#1A
City	:	ASTORIA
State	:	NY
Zip	:	11106-2536
Country	:	US
Telephone Number	:	718-721-1717
Fax Number	:

Provider Business Practice Location Address
First Line	:	3190 31ST ST
Second Line	:	#1A
City	:	ASTORIA
State	:	NY
Zip	:	11106-2536
Country	:	US
Telephone Number	:	718-721-1717
Fax Number	:

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

Provider Enumeration Date	:	01/27/2012
Last Update Date	:	01/27/2012

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