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General NPI Number Information
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NPI Number | 1083091342
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Entity Type | Organization
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Legal Business Name | SIMPLE SOLUTIONS ENDODONTICS LLC
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Dates
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Enumeration Date | 05/06/2015
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Last Update Date | 07/01/2020
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Provider Practice Location Address
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Address Line | 660 EXECUTIVE PARK CT STE 1600
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City | APOPKA
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State | FL
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Zip | 32703-6080
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Country | US
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Telephone | 407-930-4496
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Fax | 407-930-4497
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Provider Business Mailing Address
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Address Line | 660 EXECUTIVE PARK CT STE 1600
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City | APOPKA
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State | FL
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Zip | 32703-6080
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Country | US
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Telephone | 407-930-4496
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Fax | 407-930-4497
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERICKA FERGUSON
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Credential | DMD
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Telephone | 407-930-4496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN17256
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License Number State | FL
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