Healthcare Provider Details

I. General information

NPI: 1134504566
Provider Name (Legal Business Name): ERIC ANDREW NYGARD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18737 SORREL SPRINGS LN
FRENCHTOWN MT
59834-9502
US

IV. Provider business mailing address

18737 SORREL SPRINGS LN
FRENCHTOWN MT
59834-9502
US

V. Phone/Fax

Practice location:
  • Phone: 406-876-3922
  • Fax:
Mailing address:
  • Phone: 406-876-3922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11354
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number11354
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number30877
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: