Provider Demographics
NPI:1598838070
Name:FERGUSON-LAWRENCE, AMY P (DDS)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:P
Last Name:FERGUSON-LAWRENCE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 GLOVER CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:PINE GROVE
Mailing Address - State:LA
Mailing Address - Zip Code:70453-2172
Mailing Address - Country:US
Mailing Address - Phone:225-777-4591
Mailing Address - Fax:
Practice Address - Street 1:34287 LA HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70706-0665
Practice Address - Country:US
Practice Address - Phone:225-667-6889
Practice Address - Fax:225-667-6877
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA50211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1850217Medicaid
LA1881589Medicaid