Provider Demographics
NPI:1093892796
Name:FERRIS, DAVID P (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:FERRIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E GREEN BAY ST
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-2549
Mailing Address - Country:US
Mailing Address - Phone:715-524-2483
Mailing Address - Fax:715-524-5005
Practice Address - Street 1:420 E GREEN BAY ST
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-2549
Practice Address - Country:US
Practice Address - Phone:715-524-2483
Practice Address - Fax:715-524-5005
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50021421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33374900Medicaid