Gary Leroy Fredrickson, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5909 Issued in KS

Practice address

361 Grant Ave
Junction City, KS 66441-4201

Phone

(785) 238-4711

NPI assigned

Mar 16, 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

Medicare fee-for-service enrollment

Enrolled in KS

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

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

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670803200000",
    "number": "1992774582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "361 GRANT AVE",
            "city": "JUNCTION CITY",
            "state": "KS",
            "postal_code": "664414201",
            "telephone_number": "785-238-4711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "361 GRANT AVE",
            "city": "JUNCTION CITY",
            "state": "KS",
            "postal_code": "664414201",
            "telephone_number": "785-238-4711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDRICKSON",
        "first_name": "GARY",
        "middle_name": "LEROY",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-16",
        "last_updated": "2022-12-12",
        "certification_date": "2022-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KS",
            "license": "5909",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mallory Folsom
• Fannie Joyce Ford, SUPPORTIVE HOME CARE
• Khalisha Francis
• Kirsten Marie Francis
• Patrick Charles Franzen, LPC-T
• Perry Freeman, PTA
• Todd A Frieze, MD
• Challey Fullagar
• G&B Enterprises Inc
• G&B Transportation LLC

• General Practice Dentistry in Junction City, KS
• Providers in Junction City, KS by specialty
• General Practice Dentistry in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 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.