Provider Demographics
NPI:1548262314
Name:NYQUIST, WILLIAM M (DDS)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
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 1:11720 E 21ST ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-1824
Mailing Address - Country:US
Mailing Address - Phone:918-437-9111
Mailing Address - Fax:918-437-1684
Practice Address - Street 1:11720 E 21ST ST
Practice Address - Street 2:SUITE A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-1824
Practice Address - Country:US
Practice Address - Phone:918-437-9111
Practice Address - Fax:918-437-1684
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4127O1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice