Provider Demographics
NPI:1568753960
Name:LOHI DENTAL PC
Entity Type:Organization
Organization Name:LOHI DENTAL PC
Other - Org Name:PEARL DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYME
Authorized Official - Middle Name:
Authorized Official - Last Name:GLAMM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-440-9296
Mailing Address - Street 1:2200 W 29TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-4365
Mailing Address - Country:US
Mailing Address - Phone:720-440-9296
Mailing Address - Fax:720-440-9298
Practice Address - Street 1:2200 W 29TH AVE STE B
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-4365
Practice Address - Country:US
Practice Address - Phone:720-440-9296
Practice Address - Fax:720-440-9298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO96571223G0001X
CO93321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty