| Koentjoro Dentistry Dodge Llc | |
|
7059 Dodge St Ste 102 Omaha NE 68132-2703 | |
| (402) 346-6800 | |
| Not Available |
| Full Name | Koentjoro Dentistry Dodge Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 7059 Dodge St Ste 102, Omaha, Nebraska |
| Authorized Official Name and Position | Aldo Koentjoro (OWNER) |
| Authorized Official Contact | 4023466800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Koentjoro Dentistry Dodge Llc Po Box 70887 Cleveland OH 44190-0887 Ph: () - | Koentjoro Dentistry Dodge Llc 7059 Dodge St Ste 102 Omaha NE 68132-2703 Ph: (402) 346-6800 |
| NPI Number | 1659013456 |
|---|---|
| Provider Enumeration Date | 04/12/2022 |
| Last Update Date | 06/15/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659013456 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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