Provider Demographics
NPI:1093703084
Name:BOLAMPERTI, THEODORE (DDS)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:
Last Name:BOLAMPERTI
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 1:14481 W CENTER RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-5401
Mailing Address - Country:US
Mailing Address - Phone:402-330-2007
Mailing Address - Fax:402-330-2594
Practice Address - Street 1:14481 W CENTER RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5401
Practice Address - Country:US
Practice Address - Phone:402-330-2007
Practice Address - Fax:402-330-2594
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE37481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice