MEDICARE: LOHI DENTAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	9332	CO
2	1223G0001X	General Practice Dentistry	9657	CO

General Provider Information

NPI Number	:	1568753960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOHI DENTAL PC

Provider Business Mailing Address
First Line	:	2200 W 29TH AVE STE B
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-4365
Country	:	US
Telephone Number	:	720-440-9296
Fax Number	:	720-440-9298

Provider Business Practice Location Address
First Line	:	2200 W 29TH AVE STE B
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-4365
Country	:	US
Telephone Number	:	720-440-9296
Fax Number	:	720-440-9298

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAYME GLAMM
Credential	:	DDS
Telephone Number	:	720-440-9296

Provider Enumeration Date	:	04/20/2011
Last Update Date	:	04/20/2011

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Directions to “LOHI DENTAL PC ” Practice Location

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