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Scott Patrick Stadsklev

Dentist

Dental Providers

220 22nd Ave E, Suite 105, Alexandria, MN 56308

PECOS Enrollment

This provider is enrolled in PECOS as SCOTT STADSKLEV.

Based on the most recent information from CMS, provider Scott Patrick Stadsklev is legally eligible to order and refer claims for Part B, HHA and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1306905724
Provider Type
Individual
Full Name
Stadsklev, Scott Patrick
Title
Dr.
Credential
DDS

Gender
Male
Sole Proprietor
No
Enumeration Date
12/8/2006
Last Updated
7/24/2013

Contact Information

Practice Location

220 22nd Ave E, Suite 105, Alexandria, MN 56308

(320) 762-0100

(888) 763-0267

Mailing Location

220 22nd Ave E, Suite 105, Alexandria, MN 56308

(320) 762-0100

(888) 763-0267

Provider Taxonomies

Code	Description	License
Code 1223G0001X Primary	Description Dentist Dental Providers	License D12271 Minnesota

Provider Identifiers

ID	Description	Issuer
ID 613642700	Description Medicaid	Issuer Unlisted Minnesota

Scott Patrick Stadsklev

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Collins, Michael Harry

Rauk, Kimberly Ann

West Central Dental Resources Inc

Quam, Alan Douglas

Johnson, Thomas G

Dewitt, Thomas C

Aberle, Jacob Rodney

Harnish, Dennis Wayne

Cannon, David L

Thiery, Rick D