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General NPI Number Information
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NPI Number | 1013623982
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Entity Type | Organization
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Legal Business Name | BRIANNE FERGUSON DDS PLLC
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Dates
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Enumeration Date | 01/25/2023
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Last Update Date | 03/26/2023
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Provider Practice Location Address
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Address Line | 755 SEMINOLE RD STE 101
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City | NORTON SHORES
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State | MI
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Zip | 49441-6561
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Country | US
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Telephone | 219-808-2498
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Fax |
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Provider Business Mailing Address
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Address Line | 755 SEMINOLE RD STE 101
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City | NORTON SHORES
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State | MI
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Zip | 49441-6561
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Country | US
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Telephone | 231-780-3200
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Fax | 231-780-3299
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIANNE N FERGUSON
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Credential | DDS, MSD
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Telephone | 231-780-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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