Provider Demographics
NPI:1881727485
Name:THEODORE J BOLAMPERTI, LLC
Entity type:Organization
Organization Name:THEODORE J BOLAMPERTI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BOLAMPERTI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-339-3366
Mailing Address - Street 1:4864 S 96TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-2048
Mailing Address - Country:US
Mailing Address - Phone:402-339-3366
Mailing Address - Fax:
Practice Address - Street 1:4864 S 96TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-2048
Practice Address - Country:US
Practice Address - Phone:402-339-3366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE48541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty