MEDICARE: JARED HAWTHORNE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DE61235268	WA

General Provider Information

NPI Number	:	1043862279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARED HAWTHORNE DMD

Provider Business Mailing Address
First Line	:	117 E 39TH ST
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98663-2229
Country	:	US
Telephone Number	:	360-694-7931
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 E 39TH ST
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98663-2229
Country	:	US
Telephone Number	:	360-694-7931
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2019
Last Update Date	:	01/04/2023

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