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Wayne Anthony Frederickson

Dentist

Dental Providers

422 S Main St, Livingston, MT 59047-3456

PECOS Enrollment

This provider is enrolled in PECOS as WAYNE FREDERICKSON.

Based on the most recent information from CMS, provider Wayne Anthony Frederickson is legally eligible to order and refer claims for Part B, HHA and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 5 days ago.

Profile Details

Provider ID
1124172259
Provider Type
Individual
Full Name
Frederickson, Wayne Anthony
Title
Dr.
Credential
D.D.S.

Gender
Male
Sole Proprietor
No
Enumeration Date
1/23/2007
Last Updated
7/8/2007

Contact Information

Practice Location

422 S Main St, Livingston, MT 59047-3456

(406) 222-6061

(406) 222-6062

Mailing Location

422 S Main St, Livingston, MT 59047-3456

(406) 222-6061

(406) 222-6062

Provider Taxonomies

Code	Description	License
Code 1223G0001X Primary	Description Dentist Dental Providers	License 2104 Montana

Provider Identifiers

ID	Description	Issuer
ID 0112795	Description Medicaid	Issuer Unlisted Montana
ID 5512312	Description Other	Issuer CHIP Montana

Wayne Anthony Frederickson

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

Wales, Joanna Vaughey

Jagodzinski, Gary A

Shaneyfelt, Mark Edward

Schoelch, Michael L

Blavatsky, Elizabeth

Theodore K. Kulaga, D.D.S., P. C.

Scott, Kevin Graham

Venable, William J.

Livingston Dental Care