Provider Demographics
NPI:1700099280
Name:LORI M. JIMISON, DDS, PC
Entity Type:Organization
Organization Name:LORI M. JIMISON, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:JIMISON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-663-6868
Mailing Address - Street 1:3013 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 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO74791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty