Lighthouse Dental LLC

NPI #1710045224 in Raytown, Missouri

Provider Information

NPI Number: 1710045224
Entity Type: Organization
Organization Name: Lighthouse Dental LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Dec 5, 2006
Last Updated: Aug 22, 2020

Practice Location

Address: 10803A E 350 HWY
City: Raytown
State: Missouri
ZIP Code: 64138
Phone: (816) 356-2476

Authorized Official

Name: DR. JACK E FERGUSON, DDS
Title: CO OWNER DENTIST
Phone: (816) 356-2476

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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