Provider Demographics
NPI:1366977720
Name:ERIC NYGARD, DDS, PLLC
Entity type:Organization
Organization Name:ERIC NYGARD, DDS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST ANESTHESIOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:NYGARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-876-3922
Mailing Address - Street 1:18737 SORREL SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:FRENCHTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59834-9502
Mailing Address - Country:US
Mailing Address - Phone:406-876-3922
Mailing Address - Fax:
Practice Address - Street 1:18737 SORREL SPRINGS LN
Practice Address - Street 2:
Practice Address - City:FRENCHTOWN
Practice Address - State:MT
Practice Address - Zip Code:59834
Practice Address - Country:US
Practice Address - Phone:406-414-0444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1134504566261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1134504566Medicaid