Provider Demographics
NPI:1427297852
Name:FENDER, ROGER L (DDS)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:L
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 1:519 SW 3RD ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2258
Mailing Address - Country:US
Mailing Address - Phone:816-524-3434
Mailing Address - Fax:816-524-3622
Practice Address - Street 1:519 SW 3RD ST
Practice Address - Street 2:SUITE G
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2258
Practice Address - Country:US
Practice Address - Phone:816-524-3434
Practice Address - Fax:816-524-3622
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO 14150122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist