Healthcare Provider Details

I. General information

NPI: 1699764134
Provider Name (Legal Business Name): LAURA LEE NYGAARD DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 N EVERGREEN RD SUITE 102
SPOKANE VALLEY WA
99216-1485
US

IV. Provider business mailing address

1005 N EVERGREEN RD SUITE 102
SPOKANE VALLEY WA
99216-1485
US

V. Phone/Fax

Practice location:
  • Phone: 509-927-3272
  • Fax:
Mailing address:
  • Phone: 509-927-3272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number7382
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: