Provider Demographics
NPI:1790015725
Name:FJELD, JEFFREY SHAWN (DPD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SHAWN
Last Name:FJELD
Suffix:
Gender:M
Credentials:DPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 1ST ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2960
Mailing Address - Country:US
Mailing Address - Phone:360-568-3200
Mailing Address - Fax:360-568-3096
Practice Address - Street 1:1024 1ST ST STE 201
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2960
Practice Address - Country:US
Practice Address - Phone:360-568-3200
Practice Address - Fax:360-568-3096
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN 60119107122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist