Provider Demographics
NPI:1053609115
Name:KOTTEMANN, SCOTT
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:KOTTEMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13998 MAPLE KNOLL WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-7004
Mailing Address - Country:US
Mailing Address - Phone:763-420-6834
Mailing Address - Fax:
Practice Address - Street 1:13998 MAPLE KNOLL WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7004
Practice Address - Country:US
Practice Address - Phone:763-420-6834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND127371223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics