Provider Demographics
NPI:1578739553
Name:FERGUSON, ALISSA (DMD)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24024 E WINTER SPRINGS PL
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-5729
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7180 E ORCHARD RD
Practice Address - Street 2:SUITE 304
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-1724
Practice Address - Country:US
Practice Address - Phone:303-741-9949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9541122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist