Provider Demographics
NPI:1053522821
Name:DAVID FERGUSON, DDS, PA
Entity type:Organization
Organization Name:DAVID FERGUSON, DDS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:I
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-744-3181
Mailing Address - Street 1:177 GORDONHURST AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1722
Mailing Address - Country:US
Mailing Address - Phone:973-744-3181
Mailing Address - Fax:973-857-6453
Practice Address - Street 1:177 GORDONHURST AVE
Practice Address - Street 2:
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1722
Practice Address - Country:US
Practice Address - Phone:973-744-3181
Practice Address - Fax:973-337-8648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty