Provider Demographics
NPI:1730570458
Name:FERGUSON, ROBIN L (DDS)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:L
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 1:820 E 87TH ST
Mailing Address - Street 2:STE 201
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-6253
Mailing Address - Country:US
Mailing Address - Phone:773-488-9075
Mailing Address - Fax:888-506-3129
Practice Address - Street 1:820 E 87TH ST
Practice Address - Street 2:STE 201
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-6253
Practice Address - Country:US
Practice Address - Phone:773-488-9075
Practice Address - Fax:888-506-3129
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-17
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019021794122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1679737951OtherNPI