Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN 60119107 | WA |
NPI | 1790015725 |
---|---|
Provider Name | Jeffrey Shawn Fjeld |
First Address | Snohomish, WA 98290-2960 |
Second Address | Snohomish, WA 98290-2960 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2010 |
Last Update Date | 14/01/2010 |