Provider Demographics
NPI:1518910504
Name:SCOTT E STAMP DDS PLLC ROBERT W CONGDON DMD
Entity Type:Organization
Organization Name:SCOTT E STAMP DDS PLLC ROBERT W CONGDON DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:STAMP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PLLC
Authorized Official - Phone:320-252-3330
Mailing Address - Street 1:3950 VETERANS DR
Mailing Address - Street 2:#101
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-3424
Mailing Address - Country:US
Mailing Address - Phone:320-252-3330
Mailing Address - Fax:320-252-0802
Practice Address - Street 1:3950 VETERANS DR
Practice Address - Street 2:#101
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-3424
Practice Address - Country:US
Practice Address - Phone:320-252-3330
Practice Address - Fax:320-252-0802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9235122300000X
MND11508122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty