Provider Demographics
NPI:1639227424
Name:FERGUSON, MICHAEL BRIAN (BA,DMD,CAGS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRIAN
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:BA,DMD,CAGS
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:BRIAN
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA,DMD,CAGS
Mailing Address - Street 1:1 WASHINGTON SQUARE VLG
Mailing Address - Street 2:APT 14-L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-1632
Mailing Address - Country:US
Mailing Address - Phone:212-982-1570
Mailing Address - Fax:
Practice Address - Street 1:418 LAFAYETTE ST
Practice Address - Street 2:SUITE 350
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6947
Practice Address - Country:US
Practice Address - Phone:212-443-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0516131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice