Healthcare Provider Details

I. General information

NPI: 1043144082
Provider Name (Legal Business Name): JOSEPH PAUL FERGUSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3859 GRAVOIS AVE
SAINT LOUIS MO
63116-4657
US

IV. Provider business mailing address

508 STIRLING PLACE DR
MANCHESTER MO
63021-5325
US

V. Phone/Fax

Practice location:
  • Phone: 314-382-2002
  • Fax: 314-382-2411
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2026022898
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: