MR. SHAWN MIKEAL FETTIG LD NPI 1942398524

NPI Information

NPI: 1942398524
Provider Name: MR. SHAWN MIKEAL FETTIG, LD
Classification: Denturist - 122400000X
Entity Type: Individual
Address:
2701 NE 114 AVE
#K6
VANCOUVER, WA
ZIP 98684
Phone: (360) 892-7107
Get Directions

MR. Shawn Mikeal Fettig, LD is a denturist in Vancouver, WA. The provider is a denturist is a licensed professional that serves patients with removable dental prosthetic oral health needs. A licensed denturist is trained in removable dental prosthetics and the fabrication of such devices. MR. Shawn Mikeal Fettig, LD NPI is 1942398524. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2701 NE 114 AVE
#K6
VANCOUVER, WA
ZIP 98684-289
Phone: (360) 892-7107
Fax: (360) 891-8361

The enumeration date for this NPI number is 10/10/2006 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	122400000X	Denturist		ON00000393	WASHINGTON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	5047576	MEDICAID	WASHINGTON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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