# KOENTJORO DENTISTRY, DDS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245605153
- **Authorized official:** ALDO KOENTJORO DDS (OWNER)
- **Authorized official phone:** (402) 972-4400

## Contact information

- **Practice address:** 3225 OAK VIEW DR, OMAHA, NE 68144-5627
- **Practice address phone:** (402) 972-4400
- **Practice address fax:** (402) 330-4591
- **Mailing address:** PO BOX 3189, SYRACUSE, NY 13220-3189
- **Mailing address phone:** (315) 454-6000
- **Mailing address fax:** (866) 803-4943

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 6963 | NE | Yes |

## Other

- **Enumeration date:** 12/03/2015
- **Last updated:** 12/03/2015