Provider Demographics
NPI:1366051799
Name:THOMAS M JENEARY DDS PC
Entity type:Organization
Organization Name:THOMAS M JENEARY DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLES
Authorized Official - Suffix:
Authorized Official - Credentials:XDAEF
Authorized Official - Phone:712-546-4556
Mailing Address - Street 1:827 HOLTON DR
Mailing Address - Street 2:
Mailing Address - City:LE MARS
Mailing Address - State:IA
Mailing Address - Zip Code:51031-3759
Mailing Address - Country:US
Mailing Address - Phone:712-546-4556
Mailing Address - Fax:
Practice Address - Street 1:827 HOLTON DR
Practice Address - Street 2:
Practice Address - City:LE MARS
Practice Address - State:IA
Practice Address - Zip Code:51031-3759
Practice Address - Country:US
Practice Address - Phone:712-546-4556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THOMAS M JENEARY DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty