Provider Demographics
NPI:1801876792
Name:MENGHINI, FREDRICK A (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:FREDRICK
Middle Name:A
Last Name:MENGHINI
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-4599
Mailing Address - Country:US
Mailing Address - Phone:218-829-1728
Mailing Address - Fax:218-829-1729
Practice Address - Street 1:1903 S 6TH ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-4599
Practice Address - Country:US
Practice Address - Phone:218-829-1728
Practice Address - Fax:218-829-1729
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND114061223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN76B22-MEOtherBLUE PLUS MNCARE
MN86-00244OtherMEDICA MNCARE-LITTLE FALL
MN86-00245OtherMEDICA MNCARE-BRAINERD
MN86-00246OtherMEDICA MNCARE-BEMIDJI
MN933132800Medicaid
MN850000290OtherRAILROAD MEDICARE
MN86-00411OtherMEDICA MNCARE-DETROIT LAK
MN150947OtherUCARE
MN15473OtherDORAL DENTAL
MN86-00245OtherMEDICA MNCARE-BRAINERD
MN933132800Medicaid