NPIMap

Organization Active NPI

Judy Pedro-Lim

Doing business as Eagan Children's Dentistry

  • Pediatric Dentistry
  • Eagan, MN
National Provider Identifier
1316565823
Registry record updated Jul 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
JUDY PEDRO-LIM
Doing business as
Eagan Children's Dentistry
Practice address
4640 Slater Rd Ste 150
Eagan, MN 55122-4045
Phone
(651) 808-5252
Fax
(651) 808-5253
NPI assigned
Jul 10, 2020
Last updated
Jul 10, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Judy K Pedro-Lim, DMDNPI 1962574590
Title
Owner/Dentist
Phone
(651) 452-4411

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

4640 Slater Rd Ste 150
Eagan, MN 55122-4045

Mailing address

4640 Slater Rd Ste 150
Eagan, MN 55122-4045
Phone (651) 808-5252

Other names 1

  • Eagan Children's Dentistry Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594339200000",
    "number": "1316565823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4640 SLATER RD STE 150",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551224045",
            "telephone_number": "651-808-5252",
            "fax_number": "651-808-5252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4640 SLATER RD STE 150",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551224045",
            "telephone_number": "651-808-5252",
            "fax_number": "651-808-5253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUDY PEDRO-LIM",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-10",
        "last_updated": "2020-07-10",
        "certification_date": "2020-07-10",
        "status": "A",
        "authorized_official_last_name": "PEDRO-LIM",
        "authorized_official_first_name": "JUDY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "651-452-4411",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eagan Children's Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eagan, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.