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Provider Information for 1659322121

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. LARRY JETHRO FERGUSON D.M.D.

Gender: MALE

Individual NPI: 1659322121

Calendar   Last Updated:  2007-07-08
  Certification Date: 

Details

Name Value
NPI 1659322121
Enumeration Date 2006-05-12
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 1812 WALLACE SCHOOL ROAD, SUITE 400
CHARLESTON, SC 29407-4517
United States

Phone: 843-571-4411 | Fax: 843-571-1801
View Map External Link
Primary Practice Address 1812 WALLACE SCHOOL ROAD, SUITE 400
CHARLESTON, SC 29407-4517
United States

Phone: 843-571-4411 | Fax: 843-571-1801
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID SC Z22627
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice SC 2262