Provider Demographics
NPI:1699764134
Name:NYGAARD, LAURA LEE (DDS, MS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE
Last Name:NYGAARD
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 N EVERGREEN RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1485
Mailing Address - Country:US
Mailing Address - Phone:509-927-3272
Mailing Address - Fax:
Practice Address - Street 1:1005 N EVERGREEN RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1485
Practice Address - Country:US
Practice Address - Phone:509-927-3272
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA73821223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics