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General NPI Number Information
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NPI Number | 1710102819
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Entity Type | Organization
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Legal Business Name | WADSWORTH FAMILY DENTISTRY, LLC
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1374 REIMER RD
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City | WADSWORTH
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State | OH
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Zip | 44281-8164
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Country | US
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Telephone | 330-335-2525
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Fax | 330-336-1700
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Provider Business Mailing Address
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Address Line | 1374 REIMER RD
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City | WADSWORTH
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State | OH
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Zip | 44281-8164
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Country | US
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Telephone | 330-335-2525
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Fax | 330-336-1700
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Authorized Official
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Title or Position | OWNER VICE PRESIDENT
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Name | DR. TODD DAVID FERGUSON
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Credential | DDS
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Telephone | 330-335-2525
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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 |
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License Number State |
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