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General NPI Number Information
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NPI Number | 1366051799
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Entity Type | Organization
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Legal Business Name | THOMAS M JENEARY DDS PC
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Dates
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Enumeration Date | 07/31/2020
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Last Update Date | 07/31/2020
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Provider Practice Location Address
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Address Line | 827 HOLTON DR
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City | LE MARS
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State | IA
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Zip | 51031-3759
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Country | US
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Telephone | 712-546-4556
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Fax |
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Provider Business Mailing Address
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Address Line | 827 HOLTON DR
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City | LE MARS
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State | IA
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Zip | 51031-3759
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Country | US
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Telephone | 712-546-4556
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | BRENDA GALLES
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Credential | XDAEF
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Telephone | 712-546-4556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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