Healthcare Provider Details

I. General information

NPI: 1073587127
Provider Name (Legal Business Name): JAMIESUE FERGUSON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 S DALTON
BARTLETT TX
76511
US

IV. Provider business mailing address

PO BOX 309 235 S DALTON
BARTLETT TX
76511
US

V. Phone/Fax

Practice location:
  • Phone: 254-527-3993
  • Fax: 254-527-4127
Mailing address:
  • Phone: 254-527-3993
  • Fax: 254-527-4127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number17821
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: