Provider Demographics
NPI:1790160018
Name:FERGUSON, TRISHA (RDH)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 E 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-9164
Mailing Address - Country:US
Mailing Address - Phone:208-819-4954
Mailing Address - Fax:
Practice Address - Street 1:39 SHORT CUT ROAD
Practice Address - Street 2:
Practice Address - City:INCHELIUM
Practice Address - State:WA
Practice Address - Zip Code:99138-0001
Practice Address - Country:US
Practice Address - Phone:509-722-7013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH60578808124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist