Provider Demographics
NPI:1942329867
Name:FERGUSON, GILDA P (DDS)
Entity Type:Individual
Prefix:
First Name:GILDA
Middle Name:P
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12415 WHISANA LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-7536
Mailing Address - Country:US
Mailing Address - Phone:804-798-6881
Mailing Address - Fax:804-798-4558
Practice Address - Street 1:12415 WHISANA LN
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-7536
Practice Address - Country:US
Practice Address - Phone:804-798-6881
Practice Address - Fax:804-798-4558
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006793122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA190000855Medicare ID - Type UnspecifiedNON PARTICIPATION
VAU96493Medicare UPIN