Individual
BRADY KYLE FERGUSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4438 CULEBRA RD STE 3, SAN ANTONIO, TX 78228-5671
(254) 292-9844
Mailing address
517 LCR 445, GROESBECK, TX 76642-2704
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
37428
TX
Other
Enumeration date
06/15/2022
Last updated
06/15/2022
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