Provider Demographics
NPI:1841203346
Name:FERGUSON, MARK HAROLD (DMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:HAROLD
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:FORD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16226-1530
Mailing Address - Country:US
Mailing Address - Phone:724-548-1243
Mailing Address - Fax:
Practice Address - Street 1:241 LASHER RD
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-4015
Practice Address - Country:US
Practice Address - Phone:724-548-1243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024101L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice