Individual
DR. DEREK A FENDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
100 INDIAN HILLS DRIVE, PO BOX 250, MACY, NE 68039-0250
(402) 837-5381
(402) 837-5271
Mailing address
100 INDIAN HILLS DRIVE, PO BOX 250, MACY, NE 68039-0250
(402) 837-5381
(402) 837-5271
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5847
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47084147000
—
NE
01
—
688400
UNITED CONCORDIA ID #
—
01
—
7833
BCBS ID #
NE
05
—
PENDING
—
NE
Enumeration date
08/23/2006
Last updated
03/17/2018
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