Healthcare Provider Details

I. General information

NPI: 1790900231
Provider Name (Legal Business Name): WILL S FERNYHOUGH DDS PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10050 NE 10TH ST
BELLEVUE WA
98008
US

IV. Provider business mailing address

10050 NE 10TH ST
BELLEVUE WA
98008
US

V. Phone/Fax

Practice location:
  • Phone: 425-455-2020
  • Fax: 425-455-0310
Mailing address:
  • Phone: 425-455-2020
  • Fax: 425-455-0310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDE00005930
License Number StateWA

VIII. Authorized Official

Name: DR. WILL S FERNYHOUGH
Title or Position: PRESIDENT
Credential: DDS MSD
Phone: 425-455-2020