Provider Demographics
NPI:1083849558
Name:SCOTT A. ARMSTRONG, D.D.S.
Entity Type:Organization
Organization Name:SCOTT A. ARMSTRONG, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-788-5151
Mailing Address - Street 1:4001 STINSON BLVD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-3488
Mailing Address - Country:US
Mailing Address - Phone:612-788-5151
Mailing Address - Fax:612-788-9698
Practice Address - Street 1:4001 STINSON BLVD
Practice Address - Street 2:SUITE 420
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55421-3488
Practice Address - Country:US
Practice Address - Phone:612-788-5151
Practice Address - Fax:612-788-9698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN647820400Medicaid