Provider Demographics
NPI:1164635801
Name:FENDER, WILLIAM A (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:FENDER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-3014
Mailing Address - Country:US
Mailing Address - Phone:740-432-5444
Mailing Address - Fax:740-435-3256
Practice Address - Street 1:1404 PARK AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-3014
Practice Address - Country:US
Practice Address - Phone:740-432-5444
Practice Address - Fax:740-435-3256
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0161391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0406948Medicaid