Provider Demographics
NPI:1477553006
Name:FERGUSON, DAVID M (DDS MSD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 MEDICAL PKWY
Mailing Address - Street 2:STE 201
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3335
Mailing Address - Country:US
Mailing Address - Phone:512-454-6861
Mailing Address - Fax:512-454-4350
Practice Address - Street 1:4310 MEDICAL PKWY
Practice Address - Street 2:STE 201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3335
Practice Address - Country:US
Practice Address - Phone:512-454-6861
Practice Address - Fax:512-454-4350
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12561122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist