Provider Demographics
NPI:1285221655
Name:SCHWENDEMAN, FREDERICK JOSEPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:JOSEPH
Last Name:SCHWENDEMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 N 11TH AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3264
Mailing Address - Country:US
Mailing Address - Phone:406-587-5435
Mailing Address - Fax:406-587-9093
Practice Address - Street 1:108 N 11TH AVE STE 4
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3264
Practice Address - Country:US
Practice Address - Phone:406-587-5435
Practice Address - Fax:406-587-9093
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19521223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1154484897OtherNPI, TYPE 2