Provider Demographics
NPI:1831144310
Name:JUDD, JONATHAN STEWART (DDS)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:STEWART
Last Name:JUDD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 S. MONROE STREET
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204
Mailing Address - Country:US
Mailing Address - Phone:509-838-5597
Mailing Address - Fax:509-838-7195
Practice Address - Street 1:1004 S. MONROE STREET
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204
Practice Address - Country:US
Practice Address - Phone:509-838-5597
Practice Address - Fax:509-838-7195
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000093601223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5048467Medicaid