Individual provider Active NPI

Lori Ann Ross Tijerino, DDS

  • General Practice Dentistry
  • Livermore, CA
National Provider Identifier
1407077589
Registry record updated Jul 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
54031 Issued in CA
Practice address
2620 First Street
Livermore, CA 94550
Phone
(925) 940-7770
Fax
(925) 447-9308
NPI assigned
May 2, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 54031 CA Primary

Addresses

Primary practice location

2620 First Street
Livermore, CA 94550

Mailing address

2620 First Street
Livermore, CA 94550
Phone (925) 940-7770

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151117000412 CA Order and Referring Only - DentistPractitioner - Dentist 7911217245

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Lori Ross Tijerino DDS Inc. General Practice CurrentSince Aug 18, 2024 Accepting new patients

Locations

2620 1st St
Livermore, CA 94550
Phone (925) 940-7770

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721347200000",
    "number": "1407077589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2620 FIRST STREET",
            "city": "LIVERMORE",
            "state": "CA",
            "postal_code": "94550",
            "telephone_number": "925-940-7770",
            "fax_number": "925-447-9308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 FIRST STREET",
            "city": "LIVERMORE",
            "state": "CA",
            "postal_code": "94550",
            "telephone_number": "925-940-7770",
            "fax_number": "925-447-9308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIJERINO",
        "first_name": "LORI",
        "middle_name": "ANN ROSS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-02",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "54031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Livermore, CA

Sources for this page

Verify at the official NPI Registry.