Provider Demographics
NPI:1689384299
Name:JD LOTHYAN DDS PLLC
Entity Type:Organization
Organization Name:JD LOTHYAN DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-833-5137
Mailing Address - Street 1:16209 64TH ST E STE 102
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-3070
Mailing Address - Country:US
Mailing Address - Phone:253-833-5137
Mailing Address - Fax:
Practice Address - Street 1:1110 HARVEY RD NE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4218
Practice Address - Country:US
Practice Address - Phone:253-357-0592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5061395Medicaid