Provider Demographics
NPI:1083783518
Name:NYQUIST, DONALD J (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:J
Last Name:NYQUIST
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 1:524 LUDINGTON ST
Mailing Address - Street 2:DONALD J NYQUIST DDS STE 103
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-3949
Mailing Address - Country:US
Mailing Address - Phone:906-786-9585
Mailing Address - Fax:906-786-6843
Practice Address - Street 1:524 LUDINGTON ST
Practice Address - Street 2:DONALD J NYQUIST DDS PC STE 103
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-3949
Practice Address - Country:US
Practice Address - Phone:906-786-9585
Practice Address - Fax:906-786-6843
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI11103122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
D111030OtherBCBS