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General NPI Number Information
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NPI Number | 1730567371
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Entity Type | Organization
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Legal Business Name | SCOTT J. FERGUSON DDS & ASSOCIATES PLLC
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Dates
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Enumeration Date | 05/15/2015
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Last Update Date | 05/15/2015
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Provider Practice Location Address
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Address Line | 2837 STABLE DRIVE STE A
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City | KIMBALL
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State | MI
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Zip | 48074
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Country | US
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Telephone | 810-985-3301
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Fax | 855-747-1702
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Provider Business Mailing Address
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Address Line | 2837 STABLE DRIVE STE A
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City | KIMBALL
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State | MI
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Zip | 48074
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Country | US
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Telephone | 810-985-3301
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Fax | 855-747-1702
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | SCOTT J. FERGUSON
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Credential | DDS
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Telephone | 810-985-3301
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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 | 2901021197
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901018706
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 015182
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901015182
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License Number State | MI
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