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General NPI Number Information
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NPI Number | 1699201772
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Entity Type | Individual
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Provider Name | TYLER FERGUSON DMD
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Gender | Male
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Dates
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Enumeration Date | 05/10/2017
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Last Update Date | 01/25/2021
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Provider Practice Location Address
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Address Line | 3811 SENECA ST
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City | BUFFALO
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State | NY
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Zip | 14224-3434
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Country | US
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Telephone | 716-674-3737
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Fax |
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Provider Business Mailing Address
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Address Line | 462 GRIDER ST
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City | BUFFALO
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State | NY
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Zip | 14215-3021
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Country | US
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Telephone |
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 059775
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License Number State | NY
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