Provider Demographics
NPI:1215318837
Name:NYGARD, NATHAN (DDS)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:NYGARD
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 1:120 1ST ST
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-1835
Mailing Address - Country:US
Mailing Address - Phone:701-282-5930
Mailing Address - Fax:701-282-0017
Practice Address - Street 1:120 1ST ST
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-1835
Practice Address - Country:US
Practice Address - Phone:701-282-5930
Practice Address - Fax:701-282-0017
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND22591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice