Provider Demographics
NPI:1366894032
Name:FURGASON FIFE DENTISTRY LLC
Entity type:Organization
Organization Name:FURGASON FIFE DENTISTRY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FURGASON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:541-687-1442
Mailing Address - Street 1:1507 COBURG RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4853
Mailing Address - Country:US
Mailing Address - Phone:541-687-1442
Mailing Address - Fax:
Practice Address - Street 1:1507 COBURG RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4853
Practice Address - Country:US
Practice Address - Phone:541-687-1442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD100341223G0001X
ORD73311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty