Provider Demographics
NPI:1710636782
Name:FERGUSON, BLYTHE NICOLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:BLYTHE
Middle Name:NICOLE
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 1:7970 SHERIDAN BLVD
Mailing Address - Street 2:SUITE 3004
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80003
Mailing Address - Country:US
Mailing Address - Phone:303-647-5190
Mailing Address - Fax:
Practice Address - Street 1:7970 SHERIDAN BLVD
Practice Address - Street 2:SUITE 3004
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80003
Practice Address - Country:US
Practice Address - Phone:303-647-5190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002053601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice