Provider Demographics
NPI:1679391114
Name:FERGUSON, KERI LYNNEA (RDHAP)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:LYNNEA
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 HAMLIN WAY
Mailing Address - Street 2:
Mailing Address - City:LINDSAY
Mailing Address - State:CA
Mailing Address - Zip Code:93247-1525
Mailing Address - Country:US
Mailing Address - Phone:559-690-0669
Mailing Address - Fax:
Practice Address - Street 1:860 HAMLIN WAY
Practice Address - Street 2:
Practice Address - City:LINDSAY
Practice Address - State:CA
Practice Address - Zip Code:93247-1525
Practice Address - Country:US
Practice Address - Phone:559-690-0669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1110124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist