MEDICARE: DR. FREDRICK A MENGHINI D.D.S., M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	D11406	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	850000290	OTHER	MN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	76B22-ME	OTHER	MN	BLUE PLUS MNCARE
2	86-00244	OTHER	MN	MEDICA MNCARE-LITTLE FALL
3	86-00245	OTHER	MN	MEDICA MNCARE-BRAINERD
4	86-00246	OTHER	MN	MEDICA MNCARE-BEMIDJI
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	86-00411	OTHER	MN	MEDICA MNCARE-DETROIT LAK
8	150947	OTHER	MN	UCARE
9	15473	OTHER	MN	DORAL DENTAL

General Provider Information

NPI Number	:	1801876792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDRICK A MENGHINI D.D.S., M.D.

Provider Business Mailing Address
First Line	:	1903 S 6TH ST
Second Line	:
City	:	BRAINERD
State	:	MN
Zip	:	56401-4599
Country	:	US
Telephone Number	:	218-829-1728
Fax Number	:	218-829-1729

Provider Business Practice Location Address
First Line	:	1903 S 6TH ST
Second Line	:
City	:	BRAINERD
State	:	MN
Zip	:	56401-4599
Country	:	US
Telephone Number	:	218-829-1728
Fax Number	:	218-829-1729

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	05/11/2011

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