Individual
ANITA FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 327-3041
Mailing address
2720 KILBOURNE AVE, COLUMBUS, OH 43231-4804
(614) 929-1229
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.035040
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/19/2024
Last updated
05/28/2024
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