Organization
DANA E. FENDER, D.M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANA E FENDER DMD (OWNER)
(217) 356-2222
Entity
Organization
Contact information
Practice address
1715 BROADMOOR DR STE A, CHAMPAIGN, IL 61821-5984
(217) 356-2222
Mailing address
PO BOX 674467, DALLAS, TX 75267-4467
(217) 356-2222
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
19.031054
IL
Other
Enumeration date
05/04/2018
Last updated
10/13/2020
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