Provider Demographics
NPI:1518987106
Name:JIMISON, LORI MAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:MAE
Last Name:JIMISON
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 1:3013 N TAFT AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-2571
Mailing Address - Country:US
Mailing Address - Phone:970-667-6943
Mailing Address - Fax:970-667-7339
Practice Address - Street 1:3013 N TAFT AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2571
Practice Address - Country:US
Practice Address - Phone:970-667-6943
Practice Address - Fax:970-667-7339
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO74791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice