Provider Demographics
NPI:1881802395
Name:LIGHTFOOT, LORI RAMINE (DDS)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:RAMINE
Last Name:LIGHTFOOT
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 1:15547 INGLESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419-2759
Mailing Address - Country:US
Mailing Address - Phone:708-841-8159
Mailing Address - Fax:
Practice Address - Street 1:1645 COTTAGE GROVE AVE
Practice Address - Street 2:
Practice Address - City:FORD HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-3818
Practice Address - Country:US
Practice Address - Phone:708-753-5241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-021027122300000X
IL0190210271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1002723Medicaid