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General NPI Number Information
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NPI Number | 1417156704
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Entity Type | Individual
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Provider Name | MAYDA MACIAS FERGUSON D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 07/16/2007
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Last Update Date | 04/12/2018
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Provider Practice Location Address
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Address Line | 2727 HOUMA BLVD STE A
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City | METAIRIE
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State | LA
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Zip | 70006-6638
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Country | US
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Telephone | 504-833-2220
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Fax | 504-833-1411
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Provider Business Mailing Address
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Address Line | 2727 HOUMA BLVD STE A
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City | METAIRIE
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State | LA
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Zip | 70006-6638
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Country | US
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Telephone | 504-833-2220
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Fax | 504-833-1411
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 5242
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License Number State | LA
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