MEDICARE: FRED J SCHWENDEMAN, D.M.D., PC

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	261QD0000X	Dental Clinic/Center	1952	MT

General Provider Information

NPI Number	:	1154484897
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRED J SCHWENDEMAN, D.M.D., PC

Provider Business Mailing Address
First Line	:	108 N 11TH AVE
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59715-3262
Country	:	US
Telephone Number	:	406-587-5435
Fax Number	:	406-587-9093

Provider Business Practice Location Address
First Line	:	108 N 11TH AVE
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59715-3262
Country	:	US
Telephone Number	:	406-587-5435
Fax Number	:	406-587-9093

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FREDERICK JOSEPH SCHWENDEMAN
Credential	:	D.M.D.
Telephone Number	:	406-587-5435

Provider Enumeration Date	:	12/17/2006
Last Update Date	:	08/22/2020

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