Provider Demographics
NPI:1194344614
Name:JARED BLOXHAM, PLLC
Entity type:Organization
Organization Name:JARED BLOXHAM, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:V
Authorized Official - Last Name:BLOXHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-366-8607
Mailing Address - Street 1:1363 COLUMBIA PARK TRL STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4770
Mailing Address - Country:US
Mailing Address - Phone:509-578-5770
Mailing Address - Fax:
Practice Address - Street 1:1363 COLUMBIA PARK TRL STE 101
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4770
Practice Address - Country:US
Practice Address - Phone:509-578-5770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-14
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X2210XDental ProvidersDentistOrofacial PainGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies