Provider Demographics
NPI:1609133479
Name:LORI ROSS TIJERINO DDS INC.
Entity Type:Organization
Organization Name:LORI ROSS TIJERINO DDS INC.
Other - Org Name:SYCAMORE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANN ROSS
Authorized Official - Last Name:TIJERINO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-447-9300
Mailing Address - Street 1:2620 FIRST ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-2010
Mailing Address - Country:US
Mailing Address - Phone:925-447-9300
Mailing Address - Fax:925-447-9308
Practice Address - Street 1:2620 FIRST STREET
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550
Practice Address - Country:US
Practice Address - Phone:925-447-9300
Practice Address - Fax:925-447-9308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA540311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty