Provider Demographics
NPI:1245455831
Name:FERGUS, ANNE (DDS)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:
Last Name:FERGUS
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 1:2600 N MAYFAIR RD
Mailing Address - Street 2:STE 240
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1306
Mailing Address - Country:US
Mailing Address - Phone:414-258-1500
Mailing Address - Fax:414-258-9353
Practice Address - Street 1:2600 N MAYFAIR RD
Practice Address - Street 2:SUITE 505
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1309
Practice Address - Country:US
Practice Address - Phone:414-258-1500
Practice Address - Fax:414-258-9353
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50021223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics