| Ferguson Dental | |
|
101 Sheldon Blvd Se Ste 1 Grand Rapids MI 49503-4950 | |
| (616) 776-2340 | |
| (616) 776-2341 |
| Full Name | Ferguson Dental |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 101 Sheldon Blvd Se Ste 1, Grand Rapids, Michigan |
| Authorized Official Name and Position | Tasha Blackmon (CEO) |
| Authorized Official Contact | 6167762120 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ferguson Dental 100 Cherry St Se Grand Rapids MI 49503-4526 Ph: (616) 965-8200 | Ferguson Dental 101 Sheldon Blvd Se Ste 1 Grand Rapids MI 49503-4950 Ph: (616) 776-2340 |
| NPI Number | 1841449105 |
|---|---|
| Provider Enumeration Date | 09/11/2008 |
| Last Update Date | 08/25/2023 |
| Certification Date | 08/25/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841449105 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | () | Primary |
| 122300000X | Dentist | () | Secondary |
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