Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 291600489 | MI |
NPI | 1003433806 |
---|---|
Provider Name | Dr. Matthew William Ferguson |
First Address | Montague, MI 49437-1208 |
Second Address | Montague, MI 49437-1208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2020 |
Last Update Date | 29/06/2020 |