Provider Demographics
NPI:1134288608
Name:FERGUSON, A. DREW IV (DMD)
Entity Type:Individual
Prefix:DR
First Name:A.
Middle Name:DREW
Last Name:FERGUSON
Suffix:IV
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:PO BOX 529
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:31833-0529
Mailing Address - Country:US
Mailing Address - Phone:706-643-3294
Mailing Address - Fax:706-643-3296
Practice Address - Street 1:704 AVENUE C
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:GA
Practice Address - Zip Code:31833-1639
Practice Address - Country:US
Practice Address - Phone:706-643-3294
Practice Address - Fax:706-643-3296
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA110841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice