1598838070 NPI number — DR. AMY P. FERGUSON-LAWRENCE D.D.S.

Table of content: DR. AMY P. FERGUSON-LAWRENCE D.D.S. (NPI 1598838070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598838070 NPI number — DR. AMY P. FERGUSON-LAWRENCE D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERGUSON-LAWRENCE
Provider First Name:
AMY
Provider Middle Name:
P.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598838070
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
390 GLOVER CEMETERY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PINE GROVE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70453-2172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-777-4591
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34287 LA HIGHWAY 16
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENHAM SPRINGS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70706-0665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-667-6889
Provider Business Practice Location Address Fax Number:
225-667-6877
Provider Enumeration Date:
11/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  5021 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1850217 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1881589 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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