Healthcare Provider Details

I. General information

NPI: 1194344614
Provider Name (Legal Business Name): JARED BLOXHAM, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1363 COLUMBIA PARK TRL STE 101
RICHLAND WA
99352-4770
US

IV. Provider business mailing address

1363 COLUMBIA PARK TRL STE 101
RICHLAND WA
99352-4770
US

V. Phone/Fax

Practice location:
  • Phone: 509-578-5770
  • Fax:
Mailing address:
  • Phone: 509-578-5770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JARED V BLOXHAM
Title or Position: OWNER
Credential: DDS
Phone: 509-366-8607