MEDICARE: SCOTT E STAMP DDS PLLC ROBERT W CONGDON DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D11508	MN
2	122300000X	Dentist	9235	MN

General Provider Information

NPI Number	:	1518910504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT E STAMP DDS PLLC ROBERT W CONGDON DMD

Provider Business Mailing Address
First Line	:	3950 VETERANS DR
Second Line	:	#101
City	:	SAINT CLOUD
State	:	MN
Zip	:	56303-3424
Country	:	US
Telephone Number	:	320-252-3330
Fax Number	:	320-252-0802

Provider Business Practice Location Address
First Line	:	3950 VETERANS DR
Second Line	:	#101
City	:	SAINT CLOUD
State	:	MN
Zip	:	56303-3424
Country	:	US
Telephone Number	:	320-252-3330
Fax Number	:	320-252-0802

Authorized Official
Title or Position	:	OWNER
Name	:	SCOTT ERIC STAMP
Credential	:	DDS PLLC
Telephone Number	:	320-252-3330

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	08/22/2020

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