Provider Demographics
NPI:1225259963
Name:FERGUSON, WESLEY MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:MICHAEL
Last Name:FERGUSON
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:PO BOX 1407
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39760-1407
Mailing Address - Country:US
Mailing Address - Phone:662-323-2876
Mailing Address - Fax:662-323-4876
Practice Address - Street 1:405 ACADEMY RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-4019
Practice Address - Country:US
Practice Address - Phone:662-323-2876
Practice Address - Fax:662-323-4876
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3327-051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice