Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223X0400X | Orthodontists | 00203285 | CO |
Y | 1223X0400X | Orthodontists | 1383 | WY |
NPI | 1023415239 |
---|---|
Provider Name | Dr. Lori Tima |
First Address | Sheridan, WY 82801-3659 |
Second Address | Sheridan, WY 82801-3659 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2014 |
Last Update Date | 17/03/2018 |