Provider Demographics
NPI:1275733800
Name:THOMAS M JENEARY DDS PC
Entity Type:Organization
Organization Name:THOMAS M JENEARY DDS PC
Other - Org Name:JENEARY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:JENEARY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:712-546-4556
Mailing Address - Street 1:827 HOLTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:LE MARS
Mailing Address - State:IA
Mailing Address - Zip Code:51031
Mailing Address - Country:US
Mailing Address - Phone:712-546-4556
Mailing Address - Fax:712-546-4568
Practice Address - Street 1:827 HOLTON DRIVE
Practice Address - Street 2:
Practice Address - City:LE MARS
Practice Address - State:IA
Practice Address - Zip Code:51031
Practice Address - Country:US
Practice Address - Phone:712-546-4556
Practice Address - Fax:712-546-4568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA71231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
23637OtherBLUE DENTAL
236372OtherDELTA DENTAL
236372OtherDELTA DENTAL