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Individual

BRIANNE NICOLE FERGUSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
755 SEMINOLE RD STE 101, NORTON SHORES, MI 49441-6561
(231) 780-3200
Mailing address
755 SEMINOLE RD STE 101, NORTON SHORES, MI 49441-6561
(231) 780-3200

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
2901600714
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2901600714
DENTAL LICENSE
MI
Enumeration date
04/14/2020
Last updated
03/23/2023
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