Mark Wayne Froedge, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

6307 Issued in KY

Practice address

706 West Stockton Street
Edmonton, KY 42129

Phone

(270) 432-3617

Fax

(270) 432-3617

NPI assigned

Aug 31, 2006

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 1

Medicare fee-for-service enrollment

Enrolled in KY

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

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1271635200000",
    "number": "1962514737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "706 WEST STOCKTON STREET PO BOX 319",
            "city": "EDMONTON",
            "state": "KY",
            "postal_code": "42129",
            "telephone_number": "270-432-3617",
            "fax_number": "270-432-3617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "706 WEST STOCKTON STREET",
            "city": "EDMONTON",
            "state": "KY",
            "postal_code": "42129",
            "telephone_number": "270-432-3617",
            "fax_number": "270-432-3617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FROEDGE",
        "first_name": "MARK",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2010-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "6307",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60063070",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kela Everley
• Jacob Fancher
• Emily Jo Ferguson
• FH&L Family Practice LLC
• Angelia Ford
• Tina Froedge, CASE MANAGER
• Deloris Fay Garrett, CASE MANAGER
• Lisa Dawn Gearlds
• Morgan Emily Glidewell
• Golden Years Adult Day Care

• Dentist in Edmonton, KY
• Providers in Edmonton, KY by specialty
• Dentist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2010; 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.