Scott Patrick Stadsklev, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12271 Issued in MN

Practice address

220 22ND Ave E
Suite 105
Alexandria, MN 56308

Phone

(320) 762-0100

Fax

(888) 763-0267

NPI assigned

Dec 8, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374624000000",
    "number": "1306905724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 22ND AVE E",
            "address_2": "SUITE 105",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "56308",
            "telephone_number": "320-762-0100",
            "fax_number": "888-763-0267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 22ND AVE E",
            "address_2": "SUITE 105",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "56308",
            "telephone_number": "320-762-0100",
            "fax_number": "888-763-0267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STADSKLEV",
        "first_name": "SCOTT",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-08",
        "last_updated": "2013-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12271",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "613642700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shawn Michael Spoden, D.D.S.
• Sarah Jayne Sprengeler, M.D.
• Rebecca Sprenger
• St. Cloud Hospital (CentraCare Kidney Program - Alexandria Dialysis)
• St. Cloud Vamc
• Taya Staples, PHARM.D.
• Louisa Noel Steffl
• Amanda Mary Steidl
• Bobbi Louise Steidl, LSW
• Brittany Lynn Steidl

• General Practice Dentistry in Alexandria, MN
• Providers in Alexandria, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.