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General NPI Number Information
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NPI Number | 1659204584
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Entity Type | Individual
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Provider Name | SCOTT JAMES IMBERG DDS
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Gender | Male
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Dates
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Enumeration Date | 06/08/2026
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Last Update Date | 06/10/2026
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Provider Practice Location Address
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Address Line | 16220 ABERDEEN ST NE STE A1
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City | HAM LAKE
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State | MN
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Zip | 55304-5421
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Country | US
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Telephone | 763-434-4188
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Fax | 763-413-7261
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Provider Business Mailing Address
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Address Line | 90 S 9TH ST APT 1308
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City | MINNEAPOLIS
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State | MN
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Zip | 55402-3279
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Country | US
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Telephone | 218-269-3558
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D15447
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License Number State | MN
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