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Gary A Jagodzinski

Dentist

Dental Providers

422 S Main St, Livingston, MT 59047-3456

PECOS Enrollment

This provider is enrolled in PECOS as GARY JAGODZINSKI.

Based on the most recent information from CMS, provider Gary A Jagodzinski 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
1568516631
Provider Type
Individual
Full Name
Jagodzinski, Gary A
Title
Dr.
Credential
DDS

Gender
Male
Sole Proprietor
Yes
Enumeration Date
1/23/2007
Last Updated
7/8/2007

Contact Information

Practice Location

422 S Main St, Livingston, MT 59047-3456

(406) 222-0636

Mailing Location

422 S Main St, Livingston, MT 59047-3456

(406) 222-0636

Provider Taxonomies

Code	Description	License
Code 1223G0001X Primary	Description Dentist Dental Providers	License 1349 Montana

Provider Identifiers

ID	Description	Issuer
ID 0133965	Description Medicaid	Issuer Unlisted Montana
ID 5511519	Description Other	Issuer CHIP Montana
ID 13494	Description Other	Issuer BLUE CROSS BLUE SHIELD Montana

Gary A Jagodzinski

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

ID

Description

Issuer

Frederickson, Wayne Anthony

Venable, William J.

Scott, Kevin Graham

Wales, Joanna Vaughey

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

Schoelch, Michael L

Livingston Dental Care

Shaneyfelt, Mark Edward

Blavatsky, Elizabeth