MEDICARE: GREG ALAN FJERAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DE00005418	WA

General Provider Information

NPI Number	:	1659300630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREG ALAN FJERAN DDS

Provider Business Mailing Address
First Line	:	4430 106TH ST SW
Second Line	:	#101
City	:	MUKILTEO
State	:	WA
Zip	:	98275-4711
Country	:	US
Telephone Number	:	425-355-2282
Fax Number	:	425-348-5340

Provider Business Practice Location Address
First Line	:	4430 106TH ST SW
Second Line	:	#101
City	:	MUKILTEO
State	:	WA
Zip	:	98275-4711
Country	:	US
Telephone Number	:	425-355-2282
Fax Number	:	425-348-5340

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	07/08/2007

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