Individual
MR. SHAWN MIKEAL FETTIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LD
Contact information
Practice address
2701 NE 114 AVE, #K6, VANCOUVER, WA 98684-4289
(360) 892-7107
(360) 891-8361
Mailing address
2701 NE 114 AVE, #K6, VANCOUVER, WA 98684-4289
(360) 892-7107
(360) 891-8361
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
ON00000393
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5047576
—
WA
Enumeration date
10/10/2006
Last updated
07/08/2007
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