Provider Demographics
NPI:1396843892
Name:LOTHYAN, JARED (DDS)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:LOTHYAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 RENTON CENTER WAY SW STE 62
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2378
Mailing Address - Country:US
Mailing Address - Phone:425-255-5532
Mailing Address - Fax:
Practice Address - Street 1:364 RENTON CENTER WAY SW STE 62
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2378
Practice Address - Country:US
Practice Address - Phone:425-255-5532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 000108821223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry