Provider Demographics
NPI:1447794854
Name:NYGREN, AMY AURORA (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:AURORA
Last Name:NYGREN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 ERNST DR
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-8934
Mailing Address - Country:US
Mailing Address - Phone:775-342-8253
Mailing Address - Fax:
Practice Address - Street 1:901 W 4TH ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-5129
Practice Address - Country:US
Practice Address - Phone:775-386-2246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV68031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice