# LIVINGSTON DENTAL CARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639626518
- **Authorized official:** DR. WAYNE A FREDERICKSON DDS (OWNER)
- **Authorized official phone:** (406) 222-6061

## Contact information

- **Practice address:** 422 S MAIN ST, LIVINGSTON, MT 59047-3456
- **Practice address phone:** (406) 222-6061
- **Practice address fax:** (406) 222-6062
- **Mailing address:** 422 S MAIN ST, LIVINGSTON, MT 59047-3456
- **Mailing address phone:** (406) 222-6061
- **Mailing address fax:** (406) 222-6062

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 1299 | MT | — |
| 1223G0001X | General Practice Dentistry | 1835 | MT | — |
| 1223G0001X | General Practice Dentistry | 2104 | MT | Yes |
| 1223G0001X | General Practice Dentistry | 2318 | MT | — |

## Other

- **Enumeration date:** 09/08/2016
- **Last updated:** 09/08/2016