Provider Demographics
NPI:1013623982
Name:BRIANNE FERGUSON DDS PLLC
Entity type:Organization
Organization Name:BRIANNE FERGUSON DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIANNE
Authorized Official - Middle Name:N
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:231-780-3200
Mailing Address - Street 1:755 SEMINOLE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-6561
Mailing Address - Country:US
Mailing Address - Phone:231-780-3200
Mailing Address - Fax:231-780-3299
Practice Address - Street 1:755 SEMINOLE RD STE 101
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-6561
Practice Address - Country:US
Practice Address - Phone:219-808-2498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty