=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689384299
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JD LOTHYAN DDS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2022
-----------------------------------------------------
Last Update Date | 12/05/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1110 HARVEY RD NE
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98002-4218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-357-0592
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16209 64TH ST E STE 102
-----------------------------------------------------
City | SUMNER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98390-3070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-833-5137
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING INSURANCE COORDINATOR
-----------------------------------------------------
Name | JESSICA BARTLETT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 253-833-5137
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------