Provider Demographics
NPI:1659300630
Name:FJERAN, GREG ALAN (DDS)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:ALAN
Last Name:FJERAN
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 1:4430 106TH ST SW
Mailing Address - Street 2:#101
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-4711
Mailing Address - Country:US
Mailing Address - Phone:425-355-2282
Mailing Address - Fax:425-348-5340
Practice Address - Street 1:4430 106TH ST SW
Practice Address - Street 2:#101
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-4711
Practice Address - Country:US
Practice Address - Phone:425-355-2282
Practice Address - Fax:425-348-5340
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000054181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice