Camp Smile Pediatric Dentistry Excelsior PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

CAMP SMILE PEDIATRIC DENTISTRY EXCELSIOR PLLC

Doing business as

Camp Smile Pediatric Dentistry

Practice address

675 Water St Ste 2
Excelsior, MN 55331-3072

Phone

(763) 383-1788

NPI assigned

Dec 18, 2018

Last updated

Dec 18, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Bobbi L Augustyn, DDS

Title

Owner

Phone

(763) 383-1788

Specialties & licenses 1

Addresses

Other names 1

• Camp Smile Pediatric Dentistry Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Alyssa Marie Domico, DMD, MS

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Plymouth, MN
  • NPI 1871162669
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1545091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545091200000",
    "number": "1467924290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 WATER ST STE 2",
            "city": "EXCELSIOR",
            "state": "MN",
            "postal_code": "553313072",
            "telephone_number": "763-383-1788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 WATER ST STE 2",
            "city": "EXCELSIOR",
            "state": "MN",
            "postal_code": "553313072",
            "telephone_number": "763-383-1788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMP SMILE PEDIATRIC DENTISTRY EXCELSIOR PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-18",
        "last_updated": "2018-12-18",
        "status": "A",
        "authorized_official_last_name": "AUGUSTYN",
        "authorized_official_first_name": "BOBBI",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-383-1788",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Camp Smile Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Andrew Jon Bosworth, D.D.S.
• Katie Marie Moksnes Bowman, LAC
• Daniel Brandon, PT, DPT, ATC
• Annika Cameron
• Camp Smile Orthodontics Excelsior PLLC
• Capricious Corporation (kind horizons)
• Maggie Hysjulien Christ, CNP
• Gary Wayne Christensen, DENTIST
• Kevin Michael Christenson, D.C.
• Madeline Noreen Claeys, MS CCC - SLP

• Pediatric Dentistry in Excelsior, MN
• Providers in Excelsior, MN by specialty
• Pediatric Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.