Provider Demographics
NPI:1023378320
Name:NIJSSEN, LAURA ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANN
Last Name:NIJSSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:NYGAARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7545 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-7500
Mailing Address - Country:US
Mailing Address - Phone:763-422-7685
Mailing Address - Fax:
Practice Address - Street 1:501 MAIN ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1880
Practice Address - Country:US
Practice Address - Phone:763-441-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND130631223G0001X
WI7204-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice