Provider Demographics
NPI:1326157827
Name:TRESNAK, JANET SHARON (DDS)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:SHARON
Last Name:TRESNAK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 WILEY BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404
Mailing Address - Country:US
Mailing Address - Phone:319-362-7037
Mailing Address - Fax:319-396-3058
Practice Address - Street 1:3135 WILEY BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404
Practice Address - Country:US
Practice Address - Phone:319-362-7037
Practice Address - Fax:319-396-3058
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA78561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA13261578-27Medicaid