Provider Demographics
NPI:1710076880
Name:NYBOER, ANDREW HOLLAND (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:HOLLAND
Last Name:NYBOER
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 1:102 S BUCHANAN ST
Mailing Address - Street 2:NORTH SUITE
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-2090
Mailing Address - Country:US
Mailing Address - Phone:616-846-5690
Mailing Address - Fax:
Practice Address - Street 1:102 S BUCHANAN ST
Practice Address - Street 2:NORTH SUITE
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-2090
Practice Address - Country:US
Practice Address - Phone:616-846-5690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010123621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice