Provider Demographics
NPI:1366525206
Name:FERGUSON, STUART ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:ALAN
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1813 STATE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4917
Mailing Address - Country:US
Mailing Address - Phone:812-945-3099
Mailing Address - Fax:812-945-3099
Practice Address - Street 1:1813 STATE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4917
Practice Address - Country:US
Practice Address - Phone:812-945-3099
Practice Address - Fax:812-945-3099
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN12007601A1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics