Provider Demographics
NPI:1306850391
Name:FERRIS, DOUGLAS MIMS JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MIMS
Last Name:FERRIS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2418 CROSSROADS DRIVE
Mailing Address - Street 2:SUITE 2900
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53718
Mailing Address - Country:US
Mailing Address - Phone:608-442-3300
Mailing Address - Fax:
Practice Address - Street 1:2418 CROSSROADS DR
Practice Address - Street 2:SUITE 2900
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-7995
Practice Address - Country:US
Practice Address - Phone:608-442-3300
Practice Address - Fax:608-442-3303
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5797-0151223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics