Provider Demographics
NPI:1275124729
Name:CAMP SMILE ORTHODONTICS CHASKA PLLC
Entity Type:Organization
Organization Name:CAMP SMILE ORTHODONTICS CHASKA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOBBI
Authorized Official - Middle Name:L
Authorized Official - Last Name:AUGUSTYN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-383-1788
Mailing Address - Street 1:2805 CAMPUS DR STE 245
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-2678
Mailing Address - Country:US
Mailing Address - Phone:763-383-1788
Mailing Address - Fax:
Practice Address - Street 1:111 HUNDERTMARK RD STE 304N
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1587
Practice Address - Country:US
Practice Address - Phone:763-383-1788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental