Evan Andrew Frederick, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

290101005 Issued in MI

Practice address

323 W Chicago St
Coldwater, MI 49036-2805

Phone

(517) 278-6077

Fax

(517) 278-7045

NPI assigned

Jun 26, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

State licenses

Practice roles

Locations

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.

• Evan Frederick,DDS, PLLC

  • General Practice Dentistry
  • Coldwater, MI
  • NPI 1639784739
  NPD Authorized official
• Bosco P. Chan, D.D.S.

  • General Practice Dentistry
  • Coldwater, MI
  • NPI 1043650849
  NPD (past)

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

{
    "created_epoch": "1372204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642032000000",
    "number": "1770923575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "323 W CHICAGO ST",
            "city": "COLDWATER",
            "state": "MI",
            "postal_code": "490362805",
            "telephone_number": "517-278-6077",
            "fax_number": "517-278-7045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 W CHICAGO ST",
            "city": "COLDWATER",
            "state": "MI",
            "postal_code": "490362805",
            "telephone_number": "517-278-6077",
            "fax_number": "517-278-7045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICK",
        "first_name": "EVAN",
        "middle_name": "ANDREW",
        "name_prefix": "Mr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-26",
        "last_updated": "2022-01-13",
        "certification_date": "2022-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901020908",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "290101005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Heather Frank, LLMSW
• Freedom Recovery Center LLC
• Alexander Eliot Fry, LMFT
• Lubov Fry, ARNP
• Melinda Fuchs, LCSW
• G David Rubley DDS PC

• General Practice Dentistry in Coldwater, MI
• Providers in Coldwater, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2022; 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.