Provider Demographics
NPI:1073587127
Name:FERGUSON, JAMIESUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMIESUE
Middle Name:
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:PO BOX 309
Mailing Address - Street 2:235 S DALTON
Mailing Address - City:BARTLETT
Mailing Address - State:TX
Mailing Address - Zip Code:76511
Mailing Address - Country:US
Mailing Address - Phone:254-527-3993
Mailing Address - Fax:254-527-4127
Practice Address - Street 1:235 S DALTON
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TX
Practice Address - Zip Code:76511
Practice Address - Country:US
Practice Address - Phone:254-527-3993
Practice Address - Fax:254-527-4127
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17821122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist