Provider Demographics
NPI:1659431633
Name:JENEARY, THOMAS (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:JENEARY
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 1:827 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
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA71231223G0001X
IA071231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA236372OtherDELTA DENTAL
IA23637OtherBLUE DENTAL
IA1036210Medicaid