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General NPI Number Information
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NPI Number | 1922317601
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Entity Type | Organization
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Legal Business Name | WILLIAM M. NYQUIST D.D.S
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Dates
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Enumeration Date | 09/29/2010
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Last Update Date | 09/29/2010
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Provider Practice Location Address
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Address Line | 11720 E 21ST ST STE A
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City | TULSA
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State | OK
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Zip | 74129-1824
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Country | US
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Telephone | 918-437-9111
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Fax | 918-437-1684
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Provider Business Mailing Address
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Address Line | 11720 E 21ST ST STE A
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City | TULSA
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State | OK
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Zip | 74129-1824
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Country | US
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Telephone | 918-437-9111
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Fax | 918-437-1684
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Authorized Official
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Title or Position | DENTIST
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Name | DR. WILLIAM M. NYQUIST
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Credential | D.D.S.
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Telephone | 918-437-9111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4127
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License Number State | OK
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