Wayne Anthony Frederickson, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2104 Issued in MT

Practice address

422 S Main St
Livingston, MT 59047-3456

Phone

(406) 222-6061

Fax

(406) 222-6062

NPI assigned

Jan 23, 2007

Last updated

Jul 8, 2007By the provider in NPPES

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 2

Medicare fee-for-service enrollment

Enrolled in MT

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Livingston Dental Care

  • General Practice Dentistry
  • Livingston, MT
  • NPI 1639626518
  NPD Authorized official

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124172259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "422 S MAIN ST",
            "city": "LIVINGSTON",
            "state": "MT",
            "postal_code": "590473456",
            "telephone_number": "406-222-6061",
            "fax_number": "406-222-6062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "422 S MAIN ST",
            "city": "LIVINGSTON",
            "state": "MT",
            "postal_code": "590473456",
            "telephone_number": "406-222-6061",
            "fax_number": "406-222-6062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICKSON",
        "first_name": "WAYNE",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MT",
            "license": "2104",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0112795",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIP",
            "identifier": "5512312",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Benjamin N Flook, MD
• Forefront Dermatology, S.C. (SkinCare MT, A Forefront Dermatology Practice)
• Forefront Dermatology, S.C. (SkinCare MT, A Forefront Dermatology Practice)
• Dustin Thommey Fox, CMT
• Melissa Stringham Frady, LMT
• Alexis Elizabeth Freydenfelt
• Michelle Frierson, LAC
• Michael Jason Garre, DPT
• Sara Gentry
• Laurie K Gerhardt, LCSW

• General Practice Dentistry in Livingston, MT
• Providers in Livingston, MT by specialty
• General Practice Dentistry in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.