Provider Demographics
NPI:1730567371
Name:SCOTT J. FERGUSON DDS & ASSOCIATES PLLC
Entity type:Organization
Organization Name:SCOTT J. FERGUSON DDS & ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-985-3301
Mailing Address - Street 1:2837 STABLE DRIVE
Mailing Address - Street 2:STE A
Mailing Address - City:KIMBALL
Mailing Address - State:MI
Mailing Address - Zip Code:48074
Mailing Address - Country:US
Mailing Address - Phone:810-985-3301
Mailing Address - Fax:855-747-1702
Practice Address - Street 1:2837 STABLE DRIVE
Practice Address - Street 2:STE A
Practice Address - City:KIMBALL
Practice Address - State:MI
Practice Address - Zip Code:48074
Practice Address - Country:US
Practice Address - Phone:810-985-3301
Practice Address - Fax:855-747-1702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021197122300000X
MI2901018706122300000X
015182261QD0000X
MI29010151821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty