MEDICARE: RICHARD E. FERGUSON D.D.S.,M.S. PA

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	D-1669-PE	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588827125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD E. FERGUSON D.D.S.,M.S. PA

Provider Business Mailing Address
First Line	:	813 STILSON RD STE C
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83703-5119
Country	:	US
Telephone Number	:	208-344-0908
Fax Number	:	208-338-0306

Provider Business Practice Location Address
First Line	:	813 STILSON RD STE C
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83703-5119
Country	:	US
Telephone Number	:	208-344-0908
Fax Number	:	208-338-0306

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RICHARD E. FERGUSON
Credential	:	D.D.S., M.S.
Telephone Number	:	208-344-0908

Provider Enumeration Date	:	07/03/2008
Last Update Date	:	07/03/2008

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