| Dana E. Fender, D.M.D., P.C. | |
|
1715 Broadmoor Dr Ste A Champaign IL 61821-5984 | |
| (217) 356-2222 | |
| Not Available |
| Full Name | Dana E. Fender, D.M.D., P.C. |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 1715 Broadmoor Dr Ste A, Champaign, Illinois |
| Authorized Official Name and Position | Dana E Fender (OWNER) |
| Authorized Official Contact | 2173562222 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dana E. Fender, D.M.D., P.C. Po Box 674467 Dallas TX 75267-4467 Ph: (217) 356-2222 | Dana E. Fender, D.M.D., P.C. 1715 Broadmoor Dr Ste A Champaign IL 61821-5984 Ph: (217) 356-2222 |
| NPI Number | 1346739372 |
|---|---|
| Provider Enumeration Date | 05/04/2018 |
| Last Update Date | 10/13/2020 |
| Certification Date | 10/02/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346739372 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 19.031054 (Illinois) | Primary |
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