Provider Demographics
NPI:1306918578
Name:FERGUSON, LUCIAN MAXWELL (DDS)
Entity type:Individual
Prefix:DR
First Name:LUCIAN
Middle Name:MAXWELL
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2970 PEACHTREE RD NW
Mailing Address - Street 2:SUITE 460
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2192
Mailing Address - Country:US
Mailing Address - Phone:404-816-8725
Mailing Address - Fax:404-266-9665
Practice Address - Street 1:2970 PEACHTREE RD NW
Practice Address - Street 2:SUITE 460
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2192
Practice Address - Country:US
Practice Address - Phone:404-816-8725
Practice Address - Fax:404-266-9665
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7714122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist