Individual
DR. LARRY JETHRO FERGUSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1812 WALLACE SCHOOL ROAD,, SUITE 400, CHARLESTON, SC 29407-4517
(843) 571-4411
(843) 571-1801
Mailing address
1812 WALLACE SCHOOL ROAD,, SUITE 400, CHARLESTON, SC 29407-4517
(843) 571-4411
(843) 571-1801
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2262
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Z22627
—
SC
Enumeration date
05/12/2006
Last updated
07/08/2007
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