Provider Demographics
NPI:1518564293
Name:NICHOLAS FERGUSON DMD PLLC
Entity Type:Organization
Organization Name:NICHOLAS FERGUSON DMD PLLC
Other - Org Name:FERGUSON FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-381-6814
Mailing Address - Street 1:3201 S GRAND BLVD STE 2
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:503-381-6814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-06
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental