Provider Demographics
NPI:1487177838
Name:FERGUSON, NICHOLAS (DMD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
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 1:3201 S GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-2616
Mailing Address - Country:US
Mailing Address - Phone:509-747-5184
Mailing Address - Fax:509-747-0257
Practice Address - Street 1:3201 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2616
Practice Address - Country:US
Practice Address - Phone:509-747-5184
Practice Address - Fax:509-747-0257
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT17241122300000X
WA60772231122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist