Provider Demographics
NPI:1922982586
Name:LIM, NICOLE EUNHAE (DDS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:EUNHAE
Last Name:LIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E PIKES PEAK AVE APT 440
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-4277
Mailing Address - Country:US
Mailing Address - Phone:253-269-8618
Mailing Address - Fax:
Practice Address - Street 1:2280 HOGAN ST BLDG 1885
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4408
Practice Address - Country:US
Practice Address - Phone:719-526-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14226279-99261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty