Fender, Derek A
Fender, Derek A is an sole proprietor health care provider with primary practice located at 100 Indian Hills Drive Po Box 250, Macy NE 68039-0250. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Fender, Derek A can be contacted via phone (402) 837-5381.Contact Information
Primary practice address
100 Indian Hills Drive Po Box 250
Macy NE 68039-0250
Phone: (402) 837-5381
Fax: (402) 837-5271
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 5847 | Nebraska |
Profile Details
| NPI number | 1164539573 |
|---|---|
| LBN Legal business name | Fender, Derek A |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 23rd, 2006 |
| Last updated | Mar 17th, 2018 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1164539573 | NPPES |
| Nebraska | MEDICAID | PENDING | |
| Nebraska | MEDICAID | 47084147000 | |
| Nebraska | Other | 688400 | |
| Nebraska | Other | 7833 |
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