Individual
DR. KOBY FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
620 JOHN PAUL JONES CIR, PORTSMOUTH, VA 23708-2111
(785) 452-0731
Mailing address
620 JOHN PAUL JONES CIR, PORTSMOUTH, VA 23708-2111
(785) 452-0731
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
60898
KS
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
0438000482
VA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
60898
KS
Other
Enumeration date
12/15/2011
Last updated
06/21/2023
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