Provider Demographics
NPI:1548315575
Name:THOMAS R. NALEPKA D.D.S
Entity type:Organization
Organization Name:THOMAS R. NALEPKA D.D.S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JOLYN
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:309-694-0606
Mailing Address - Street 1:809 W CAMP ST
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611
Mailing Address - Country:US
Mailing Address - Phone:309-694-0606
Mailing Address - Fax:309-694-0677
Practice Address - Street 1:809 W CAMP ST
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611
Practice Address - Country:US
Practice Address - Phone:309-694-0606
Practice Address - Fax:309-694-0677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0190184031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty