Provider Demographics
NPI:1669512349
Name:FERGUSON, JAMIE MARC (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:MARC
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 1:318 9TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2805
Mailing Address - Country:US
Mailing Address - Phone:858-793-4680
Mailing Address - Fax:858-793-1160
Practice Address - Street 1:318 9TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2805
Practice Address - Country:US
Practice Address - Phone:858-793-4680
Practice Address - Fax:858-793-1160
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51578122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist