Healthcare Provider Details

I. General information

NPI: 1831144310
Provider Name (Legal Business Name): JONATHAN STEWART JUDD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 S. MONROE STREET
SPOKANE WA
99204
US

IV. Provider business mailing address

1004 S. MONROE STREET
SPOKANE WA
99204
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-5597
  • Fax: 509-838-7195
Mailing address:
  • Phone: 509-838-5597
  • Fax: 509-838-7195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDE00009360
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: