Provider Demographics
NPI:1467537894
Name:HAJEK, THOMAS JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOHN
Last Name:HAJEK
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 1:530 IOWA AVE SE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-2864
Mailing Address - Country:US
Mailing Address - Phone:605-352-3183
Mailing Address - Fax:605-352-3170
Practice Address - Street 1:530 IOWA AVE SE
Practice Address - Street 2:SUITE 103
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-2864
Practice Address - Country:US
Practice Address - Phone:605-352-3183
Practice Address - Fax:605-352-3170
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM-4371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7804060Medicaid
SDM-437OtherLICSENCE
SDAH7117509OtherDEA