Provider Demographics
NPI:1679898902
Name:PSPD - MONROE, PLLC
Entity type:Organization
Organization Name:PSPD - MONROE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT RECEIVABLE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-863-8700
Mailing Address - Street 1:14090 FRYELANDS BLVD SE STE 348
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-2760
Mailing Address - Country:US
Mailing Address - Phone:360-863-8700
Mailing Address - Fax:360-822-7184
Practice Address - Street 1:14090 FRYELANDS BLVD SE STE 348
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-2760
Practice Address - Country:US
Practice Address - Phone:360-863-8700
Practice Address - Fax:360-822-7184
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUGO DMD MARYSVILLE PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-30
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000099181223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty