Provider Demographics
NPI:1528191434
Name:FERGUSON, DAVID IAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:IAN
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 GORDONHURST AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1722
Mailing Address - Country:US
Mailing Address - Phone:973-744-3181
Mailing Address - Fax:973-857-6453
Practice Address - Street 1:177 GORDONHURST AVE
Practice Address - Street 2:
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1722
Practice Address - Country:US
Practice Address - Phone:973-744-3181
Practice Address - Fax:973-857-6453
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI019926001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice