MEDICARE: SCOTT GENE FERGUSON JR. D.D.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	1223P0300X	Periodontics	272251-9922	UT
2	1223P0300X	Periodontics	202782	CO

General Provider Information

NPI Number	:	1427125731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT GENE FERGUSON JR. D.D.S.

Provider Business Mailing Address
First Line	:	122 S. MOUNTAIN RD.
Second Line	:
City	:	FRUIT HEIGHTS
State	:	UT
Zip	:	84037
Country	:	US
Telephone Number	:	801-989-1492
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 S. MOUNTAIN RD.
Second Line	:
City	:	FRUIT HEIGHTS
State	:	UT
Zip	:	84037
Country	:	US
Telephone Number	:	801-989-1492
Fax Number	:

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	03/20/2017

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