Provider Demographics
NPI:1023469723
Name:NYGAARD SPELLMAN, STACEY (DDS)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:NYGAARD SPELLMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2761 W 120TH AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2980
Mailing Address - Country:US
Mailing Address - Phone:303-457-2266
Mailing Address - Fax:303-457-0464
Practice Address - Street 1:2761 W 120TH AVE STE 220
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2980
Practice Address - Country:US
Practice Address - Phone:303-457-2266
Practice Address - Fax:303-457-0464
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO203902122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist