Provider Demographics
NPI:1992077242
Name:STALLMAN, BRANDI LEE (ADT)
Entity type:Individual
Prefix:MS
First Name:BRANDI
Middle Name:LEE
Last Name:STALLMAN
Suffix:
Gender:F
Credentials:ADT
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:LEE
Other - Last Name:TWEETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ADT
Mailing Address - Street 1:209 SOUTH 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:MONTEVIDEO
Mailing Address - State:MN
Mailing Address - Zip Code:56265
Mailing Address - Country:US
Mailing Address - Phone:320-269-6406
Mailing Address - Fax:320-269-6408
Practice Address - Street 1:315 N 1ST ST
Practice Address - Street 2:
Practice Address - City:MONTEVIDEO
Practice Address - State:MN
Practice Address - Zip Code:56265-1405
Practice Address - Country:US
Practice Address - Phone:320-269-6406
Practice Address - Fax:320-269-6408
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA8742126800000X
MNADT10125K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125K00000XDental ProvidersAdvanced Practice Dental Therapist
No126800000XDental ProvidersDental Assistant