Healthcare Provider Details

I. General information

NPI: 1518372556
Provider Name (Legal Business Name): JOHN D FERRIN DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2014
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 E BARNETT RD
MEDFORD OR
97504-8309
US

IV. Provider business mailing address

2930 E BARNETT RD
MEDFORD OR
97504-8309
US

V. Phone/Fax

Practice location:
  • Phone: 541-779-4501
  • Fax:
Mailing address:
  • Phone: 541-779-4501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number StateOR

VIII. Authorized Official

Name: DR. JOHN DAVID FERRIN
Title or Position: OWNER, PERIODONTIST
Credential: DMD, MS
Phone: 541-944-5745