Provider Demographics
NPI:1881075257
Name:NYGARD, RYAN SCOTT
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:SCOTT
Last Name:NYGARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 25TH ST S
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6162
Mailing Address - Country:US
Mailing Address - Phone:701-280-0088
Mailing Address - Fax:701-293-5602
Practice Address - Street 1:3011 25TH ST S
Practice Address - Street 2:SUITE 1
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6162
Practice Address - Country:US
Practice Address - Phone:701-280-0088
Practice Address - Fax:701-293-5602
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND22601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice