OrganizationLivingston Dental CareDentistDental ProvidersPractice Address422 S Main St, Livingston, MT 59047-3456(406) 222-6061PECOS EnrollmentBased on the most recent information from CMS, provider Livingston Dental Care does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1639626518Provider TypeOrganizationFull NameLivingston Dental CareSubpartNoEnumeration Date9/8/2016Last Updated9/8/2016Contact InformationPractice LocationPractice Address422 S Main St, Livingston, MT 59047-3456Phone(406) 222-6061Fax(406) 222-6062Mailing LocationMailing Address422 S Main St, Livingston, MT 59047-3456Phone(406) 222-6061Fax(406) 222-6062Authorized OfficialNameFrederickson, Wayne A (Owner)Phone(406) 222-6061Provider TaxonomiesCodeDescriptionLicenseCode1223G0001XPrimaryDescriptionDentistDental ProvidersLicense2104MontanaCode1223G0001XDescriptionDentistDental ProvidersLicense2318MontanaCode1223G0001XDescriptionDentistDental ProvidersLicense1299MontanaCode1223G0001XDescriptionDentistDental ProvidersLicense1835Montana