Provider Demographics
NPI:1659143923
Name:CAMP SMILE NEBRASKA LLC
Entity Type:Organization
Organization Name:CAMP SMILE NEBRASKA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RCM SENIOR SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:POTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-860-6323
Mailing Address - Street 1:1007 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:SCHUYLER
Mailing Address - State:NE
Mailing Address - Zip Code:68661-6218
Mailing Address - Country:US
Mailing Address - Phone:612-234-4142
Mailing Address - Fax:
Practice Address - Street 1:1007 N SHORE DR
Practice Address - Street 2:
Practice Address - City:SCHUYLER
Practice Address - State:NE
Practice Address - Zip Code:68661-6218
Practice Address - Country:US
Practice Address - Phone:612-234-4142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty