Provider Demographics
NPI:1144311283
Name:SHAMBLOTT, SCOTT ELLIOT (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ELLIOT
Last Name:SHAMBLOTT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 10TH AVENUE S
Mailing Address - Street 2:SUITE 340
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343
Mailing Address - Country:US
Mailing Address - Phone:952-935-5599
Mailing Address - Fax:952-935-7842
Practice Address - Street 1:33 10TH AVENUE S
Practice Address - Street 2:SUITE 340
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343
Practice Address - Country:US
Practice Address - Phone:952-935-5599
Practice Address - Fax:952-935-7842
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11162122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist