Provider Demographics
NPI:1497209795
Name:FERGUSON FAMILY DENTISTRY PC
Entity Type:Organization
Organization Name:FERGUSON FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-335-6535
Mailing Address - Street 1:5 BAYARD RD
Mailing Address - Street 2:APT 116
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213
Mailing Address - Country:US
Mailing Address - Phone:412-335-6535
Mailing Address - Fax:
Practice Address - Street 1:4880 LIBRARY ROAD
Practice Address - Street 2:SUITE F
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102
Practice Address - Country:US
Practice Address - Phone:412-831-3853
Practice Address - Fax:412-831-7425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0384011223G0001X
PADS0383991223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty