Organization
RICHARD E. FERGUSON D.D.S.,M.S. PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD E. FERGUSON D.D.S., M.S. (OWNER)
(208) 344-0908
Entity
Organization
Contact information
Practice address
813 STILSON RD STE C, BOISE, ID 83703-5119
(208) 344-0908
(208) 338-0306
Mailing address
813 STILSON RD STE C, BOISE, ID 83703-5119
(208) 344-0908
(208) 338-0306
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
D-1669-PE
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000195500
—
ID
Enumeration date
07/03/2008
Last updated
07/03/2008
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