Provider Demographics
NPI:1154484897
Name:FRED J SCHWENDEMAN, D.M.D., PC
Entity type:Organization
Organization Name:FRED J SCHWENDEMAN, D.M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SCHWENDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:406-587-5435
Mailing Address - Street 1:108 N 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3262
Mailing Address - Country:US
Mailing Address - Phone:406-587-5435
Mailing Address - Fax:406-587-9093
Practice Address - Street 1:108 N 11TH AVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3262
Practice Address - Country:US
Practice Address - Phone:406-587-5435
Practice Address - Fax:406-587-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1952261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental