Provider Demographics
NPI:1528163318
Name:FERGUSON, ROBERT YOUNG JR (DDS PA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:YOUNG
Last Name:FERGUSON
Suffix:JR
Gender:M
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10123 LAKE CREEK PKWY
Mailing Address - Street 2:BLDG 2
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729
Mailing Address - Country:US
Mailing Address - Phone:512-250-8101
Mailing Address - Fax:512-258-7154
Practice Address - Street 1:10123 LAKE CREEK PKWY
Practice Address - Street 2:BLDG 2
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729
Practice Address - Country:US
Practice Address - Phone:512-250-8101
Practice Address - Fax:512-258-7154
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX140491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice