# DR. DEREK A FENDER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1164539573
- **Gender:** Man
- **Credential:** D.D.S.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 5847 | NE | Yes |

## Other

- **Enumeration date:** 08/23/2006
- **Last updated:** 03/17/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 47084147000 | — | NE |
| 01 | — | 688400 | UNITED CONCORDIA ID \# | — |
| 01 | — | 7833 | BCBS ID \# | NE |
| 05 | — | PENDING | — | NE |