Provider Demographics
NPI:1104868306
Name:AUGUSTYN, BOBBI (DDS)
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:
Last Name:AUGUSTYN
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 1:5231 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-2336
Mailing Address - Country:US
Mailing Address - Phone:402-551-2238
Mailing Address - Fax:402-551-4314
Practice Address - Street 1:5231 CENTER ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-2336
Practice Address - Country:US
Practice Address - Phone:402-551-2238
Practice Address - Fax:402-551-4314
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE65361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1756016OtherUNITED CONCORDIA PROVIDER