Provider Demographics
NPI:1548955701
Name:FERGUSON, ALEXANDRA ELIZABETH (DDS)
Entity type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:ELIZABETH
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 TIVOLI TERRACE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550
Mailing Address - Country:US
Mailing Address - Phone:256-490-0587
Mailing Address - Fax:
Practice Address - Street 1:136 PARTIN DR N
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2054
Practice Address - Country:US
Practice Address - Phone:850-605-0579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL28264122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes122300000XDental ProvidersDentist