Provider Demographics
NPI:1891726147
Name:FERGUSON, RICHARD B JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
Last Name:FERGUSON
Suffix:JR
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 1:814 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4501
Mailing Address - Country:US
Mailing Address - Phone:253-272-7574
Mailing Address - Fax:253-272-9044
Practice Address - Street 1:814 6TH AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4501
Practice Address - Country:US
Practice Address - Phone:253-272-7574
Practice Address - Fax:253-272-9044
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA63451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice