MEDICARE: DR. PARKER J FERGUSON DDS

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	122300000X	Dentist	30.027202	OH

General Provider Information

NPI Number	:	1558053033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PARKER J FERGUSON DDS

Provider Business Mailing Address
First Line	:	2925 ANGELO JOSEPH LN APT 106
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-3998
Country	:	US
Telephone Number	:	801-726-1991
Fax Number	:

Provider Business Practice Location Address
First Line	:	4121 E MAIN ST
Second Line	:
City	:	WHITEHALL
State	:	OH
Zip	:	43213-2951
Country	:	US
Telephone Number	:	614-231-8000
Fax Number	:	614-349-3347

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

Provider Enumeration Date	:	05/23/2023
Last Update Date	:	06/29/2023

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