MEDICARE: DR. DAVID B. FERGUSON D.D.S., M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	015421	MO

General Provider Information

NPI Number	:	1235111444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID B. FERGUSON D.D.S., M.S.

Provider Business Mailing Address
First Line	:	3145 GARDEN AVE RM 110
Second Line	:
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-7718
Country	:	US
Telephone Number	:	210-808-3737
Fax Number	:	210-808-3802

Provider Business Practice Location Address
First Line	:	3145 GARDEN AVE RM 110
Second Line	:
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-7718
Country	:	US
Telephone Number	:	210-808-3737
Fax Number	:	210-808-3802

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	01/18/2023

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