Provider Demographics
NPI:1952090771
Name:WILLIAM FERGUSON DMD PC
Entity Type:Organization
Organization Name:WILLIAM FERGUSON DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-868-7155
Mailing Address - Street 1:4469 COLUMBIA RD STE F
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-4571
Mailing Address - Country:US
Mailing Address - Phone:706-868-7155
Mailing Address - Fax:
Practice Address - Street 1:4469 COLUMBIA RD STE F
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-4571
Practice Address - Country:US
Practice Address - Phone:706-868-7155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental