Provider Demographics
NPI:1215465059
Name:CYR, AUDREY L (DDS)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:L
Last Name:CYR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 MAPLE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1811
Mailing Address - Country:US
Mailing Address - Phone:218-722-1070
Mailing Address - Fax:218-733-0959
Practice Address - Street 1:1832 MAPLE GROVE RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-1811
Practice Address - Country:US
Practice Address - Phone:218-722-1070
Practice Address - Fax:218-733-0959
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND138091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice