Provider Demographics
NPI:1164802559
Name:FENDER, AMY (DDS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:FENDER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 CHURCHGROVE RD
Mailing Address - Street 2:STE. 2
Mailing Address - City:FRANKENMUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48734-1029
Mailing Address - Country:US
Mailing Address - Phone:989-652-6271
Mailing Address - Fax:989-652-2501
Practice Address - Street 1:123 CHURCHGROVE RD
Practice Address - Street 2:STE. 2
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734-1029
Practice Address - Country:US
Practice Address - Phone:989-652-6271
Practice Address - Fax:989-652-2501
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010167251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice