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General NPI Number Information
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NPI Number | 1003361791
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Entity Type | Organization
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Legal Business Name | VALUDENTAL GLADSTONE FERGUSON DDS
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Dates
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Enumeration Date | 08/23/2016
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Last Update Date | 01/09/2017
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Provider Practice Location Address
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Address Line | 319 NE VIVION RD
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City | KANSAS CITY
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State | MO
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Zip | 64118-4510
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Country | US
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Telephone | 210-451-0000
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Fax | 210-233-8829
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Provider Business Mailing Address
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Address Line | 319 NE VIVION RD
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City | KANSAS CITY
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State | MO
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Zip | 64118-4510
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Country | US
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Telephone | 210-451-0000
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Fax | 210-233-8829
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Authorized Official
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Title or Position | OWNER
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Name | DAVID B FERGUSON
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Credential | DDS, CAGS
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Telephone | 210-451-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2008028696
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License Number State | MO
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