Provider Demographics
NPI:1891139473
Name:FERGUSON, PATRICK RYAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:RYAN
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JARRETT WHITE RD BLDG 320
Mailing Address - Street 2:ATTN: MCDS-PA
Mailing Address - City:TRIPLER ARMY MEDICAL CENTER
Mailing Address - State:HI
Mailing Address - Zip Code:96859-5001
Mailing Address - Country:US
Mailing Address - Phone:808-433-5303
Mailing Address - Fax:808-433-9194
Practice Address - Street 1:1 JARRETT WHITE RD BLDG 320
Practice Address - Street 2:ATTN: MCDS-PA
Practice Address - City:TRIPLER AMC
Practice Address - State:HI
Practice Address - Zip Code:96859-5001
Practice Address - Country:US
Practice Address - Phone:808-433-5303
Practice Address - Fax:808-433-9194
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61875122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist