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General NPI Number Information
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NPI Number | 1154484897
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Entity Type | Organization
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Legal Business Name | FRED J SCHWENDEMAN, D.M.D., PC
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Dates
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Enumeration Date | 12/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 108 N 11TH AVE
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City | BOZEMAN
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State | MT
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Zip | 59715-3262
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Country | US
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Telephone | 406-587-5435
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Fax | 406-587-9093
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Provider Business Mailing Address
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Address Line | 108 N 11TH AVE
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City | BOZEMAN
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State | MT
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Zip | 59715-3262
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Country | US
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Telephone | 406-587-5435
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Fax | 406-587-9093
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FREDERICK JOSEPH SCHWENDEMAN
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Credential | D.M.D.
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Telephone | 406-587-5435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 1952
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License Number State | MT
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