Provider Demographics
NPI:1417156704
Name:FERGUSON, MAYDA MACIAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAYDA
Middle Name:MACIAS
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 1:2727 HOUMA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-6638
Mailing Address - Country:US
Mailing Address - Phone:504-833-2220
Mailing Address - Fax:504-833-1411
Practice Address - Street 1:2727 HOUMA BLVD STE A
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-6638
Practice Address - Country:US
Practice Address - Phone:504-833-2220
Practice Address - Fax:504-833-1411
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA52421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice