Provider Demographics
NPI:1588798839
Name:JARED D. LOTHYAN DDS, PS
Entity Type:Organization
Organization Name:JARED D. LOTHYAN DDS, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:D
Authorized Official - Last Name:LOTHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PS
Authorized Official - Phone:425-255-5532
Mailing Address - Street 1:364 RENTON CENTER WAY SW #62
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057
Mailing Address - Country:US
Mailing Address - Phone:425-255-5532
Mailing Address - Fax:425-255-1658
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:98055-2378
Practice Address - Country:US
Practice Address - Phone:425-255-5532
Practice Address - Fax:425-255-1658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty