Individual provider Active NPI

Amalou Villanueva Lim, D.D.S.

  • General Practice Dentistry
  • Cocoa, FL
National Provider Identifier
1508869876
Registry record updated Jan 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
HAD128 Issued in FL
Practice address
7227 N US Highway 1
Cocoa, FL 32927-5020
Phone
(321) 241-6800
Fax
(321) 241-6890
NPI assigned
May 31, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 019022168 IL
General Practice Dentistry 1223G0001X HAD128 FL Primary

Addresses

Primary practice location

7227 N US Highway 1
Cocoa, FL 32927-5020

Mailing address

PO Box 1137
Melbourne, FL 32902-1137
Phone (321) 241-6800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240124003608 FL Practitioner - Dentist 9638572670 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019022168ILMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Brevard Health Alliance Inc CurrentSince Jan 22, 2024 Accepting new patients
Brevard Health Alliance Inc Current Accepting new patients
Brevard Health Alliance, Inc. CurrentSince Jan 22, 2024 Accepting new patients
Palatine Dentistry PC Past Accepting new patients

Locations

2120 Sarno Rd
Melbourne, FL 32935
Phone (321) 952-9696

7227 N US Highway 1
Port St John, FL 32927
Phone (321) 631-3693

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1117497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705622400000",
    "number": "1508869876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1137",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329021137",
            "telephone_number": "321-241-6800",
            "fax_number": "321-241-6890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7227 N US HIGHWAY 1",
            "city": "COCOA",
            "state": "FL",
            "postal_code": "329275020",
            "telephone_number": "321-241-6800",
            "fax_number": "321-241-6890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIM",
        "first_name": "AMALOU",
        "middle_name": "VILLANUEVA",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-05-31",
        "last_updated": "2024-01-19",
        "certification_date": "2024-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019022168",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "HAD128",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cocoa, FL

Sources for this page

Verify at the official NPI Registry.