MEDICARE: SCOT STROMSTA DDS

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	012397	MI

General Provider Information

NPI Number	:	1700996550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOT STROMSTA DDS

Provider Business Mailing Address
First Line	:	712 WEST CENTRE AVE
Second Line	:
City	:	PORTAGE
State	:	MI
Zip	:	49024-5310
Country	:	US
Telephone Number	:	269-323-0335
Fax Number	:	269-323-3396

Provider Business Practice Location Address
First Line	:	712 WEST CENTRE AVE
Second Line	:
City	:	PORTAGE
State	:	MI
Zip	:	49024-5310
Country	:	US
Telephone Number	:	269-323-0335
Fax Number	:	269-323-3396

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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Directions to “ SCOT STROMSTA DDS” Practice Location

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