Provider Demographics
NPI:1720215957
Name:FERGUSON FORAL, LAURA CHRISTINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:CHRISTINE
Last Name:FERGUSON FORAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 N 167TH CT
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-8067
Mailing Address - Country:US
Mailing Address - Phone:402-991-6965
Mailing Address - Fax:
Practice Address - Street 1:3811 N 167TH CT
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-8067
Practice Address - Country:US
Practice Address - Phone:402-991-6965
Practice Address - Fax:402-991-6985
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE68241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice