Provider Demographics
NPI:1811440662
Name:DE PAULA LIMA PEREIRA, SAMELA THAIS (DDS)
Entity type:Individual
Prefix:
First Name:SAMELA THAIS
Middle Name:
Last Name:DE PAULA LIMA PEREIRA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SAMELA THAIS
Other - Middle Name:
Other - Last Name:DE PAULA LIMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:800 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-7001
Mailing Address - Country:US
Mailing Address - Phone:859-323-3368
Mailing Address - Fax:
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-2913
Practice Address - Country:US
Practice Address - Phone:859-323-3368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10373122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist