Provider Demographics
NPI:1225259260
Name:BLANKENAU, THOMAS GERARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GERARD
Last Name:BLANKENAU
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 1:6754 OLD DOMINION RD.
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5451
Mailing Address - Country:US
Mailing Address - Phone:402-420-1002
Mailing Address - Fax:
Practice Address - Street 1:5945 SO. 56TH ST. STE. 101
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-3394
Practice Address - Country:US
Practice Address - Phone:402-423-9344
Practice Address - Fax:402-423-5662
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE52501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice