Provider Demographics
NPI:1730758079
Name:AUGUSTYN, EVAN MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:MICHAEL
Last Name:AUGUSTYN
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 1:6703 S LOUISE AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5982
Mailing Address - Country:US
Mailing Address - Phone:605-271-9330
Mailing Address - Fax:
Practice Address - Street 1:6703 S LOUISE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5982
Practice Address - Country:US
Practice Address - Phone:605-271-9330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD13161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice