Active NPI
Trevor Mathias Bauer Frideres, D.M.D.
- General Practice Dentistry
- Sisters, OR
National Provider Identifier
1629401575
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D10577
- Practice address
- 410 E Cascade Ave
Sisters, OR 97759 - Phone
- (541) 549-9486
- Fax
- (541) 549-9110
- NPI assigned
- Aug 14, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D10577 | OR | Primary |
| Dentist | 122300000X | DE60394053 | WA |
Addresses
Primary practice location
410 E Cascade Ave
Sisters, OR 97759
Mailing address
PO Box 1027
Sisters, OR 97759-1027
Phone (541) 549-9486
Other practice location 1
605 S Coolidge St
Moses Lake, WA 98837-1893
Phone (509) 766-8977
Other names 1
- Trevor Mathias Frideres
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D10577 | OR | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frideres Dental LLC | General Practice | Past | Accepting new patients |
| Frideres Dental LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dental Clinic/Center
- Sisters, OR
- NPI 1689182933
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1376438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548547200000",
"number": "1629401575",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1027",
"city": "SISTERS",
"state": "OR",
"postal_code": "977591027",
"telephone_number": "541-549-9486",
"fax_number": "541-549-9110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 E CASCADE AVE",
"city": "SISTERS",
"state": "OR",
"postal_code": "97759",
"telephone_number": "541-549-9486",
"fax_number": "541-549-9110"
}
],
"practiceLocations": [
{
"address_1": "605 S Coolidge St",
"address_purpose": "LOCATION",
"city": "Moses Lake",
"state": "WA",
"postal_code": "988371893",
"country_code": "US",
"telephone_number": "509-766-8977",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FRIDERES",
"first_name": "TREVOR",
"middle_name": "MATHIAS BAUER",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-08-14",
"last_updated": "2019-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OR",
"license": "D10577",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "DE60394053",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "TREVOR",
"last_name": "FRIDERES",
"middle_name": "MATHIAS",
"credential": "D.M.D.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Sisters, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.