Derek A Fender, D.D.S.
Individual provider Active NPI General Practice Dentistry · Macy, NE
NPI 1164539573 · NPPES record last updated Mar 17, 2018
Key facts
- NPI
- 1164539573
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 5847 (NE)
- Practice address
- 100 Indian Hills Drive
PO Box 250
Macy, NE 68039-0250 - Phone
- (402) 837-5381
- Fax
- (402) 837-5271
- NPI assigned
- Aug 23, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5847 | NE | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5847 | NE | Yes |
Addresses
Primary practice location
100 Indian Hills Drive
PO Box 250
Macy, NE 68039-0250
Mailing address
100 Indian Hills Drive
PO Box 250
Macy, NE 68039-0250
Phone (402) 837-5381
Other practice location 1
1209 Harney St
Suite 200
Omaha, NE 68102-1894
Phone (402) 342-3901
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PENDING | Medicaid | NE | |
| 47084147000 | Medicaid | NE | |
| 688400 | Other | UNITED CONCORDIA ID # | |
| 7833 | Other | NE | BCBS ID # |
Other providers in Macy, NE
- Carl T Curtis Health Education Center
- Kelly Olsson Cromer
- Audrey Kay Cross
- Charles A Dearborn
- Sarah Mari Farrens
- Ronald James Freemont Jr.
- Jeffrey Gildow
- Robin R Gordon
- Donald F Grant
- Joyce Marie Grant
All providers in Macy, NE · General Practice Dentistry in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.