Provider Demographics
NPI:1588705529
Name:FERGUSON, LYNN ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:ALAN
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 1:1222 E. MISSOURI AVE.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014
Mailing Address - Country:US
Mailing Address - Phone:602-242-5445
Mailing Address - Fax:602-242-8374
Practice Address - Street 1:1222 E. MISSOURI AVE.
Practice Address - Street 2:SUITE 201
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014
Practice Address - Country:US
Practice Address - Phone:602-242-5445
Practice Address - Fax:602-242-8374
Is Sole Proprietor?:No
Enumeration Date:2007-02-11
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD44381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice