Provider Demographics
NPI:1790900231
Name:WILL S FERNYHOUGH DDS PS
Entity Type:Organization
Organization Name:WILL S FERNYHOUGH DDS PS
Other - Org Name:FERNYHOUGH PERIODONTICS PREMIER PERIODONTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILL
Authorized Official - Middle Name:S
Authorized Official - Last Name:FERNYHOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MSD
Authorized Official - Phone:425-455-2020
Mailing Address - Street 1:10050 NE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008
Mailing Address - Country:US
Mailing Address - Phone:425-455-2020
Mailing Address - Fax:425-455-0310
Practice Address - Street 1:10050 NE 10TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008
Practice Address - Country:US
Practice Address - Phone:425-455-2020
Practice Address - Fax:425-455-0310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000059301223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty