# KOENTJORO DENTISTRY DODGE LLC

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

## Provider details

- **NPI number:** 1659013456
- **Authorized official:** ALDO KOENTJORO (OWNER)
- **Authorized official phone:** (402) 346-6800

## Contact information

- **Practice address:** 7059 DODGE ST STE 102, OMAHA, NE 68132-2703
- **Practice address phone:** (402) 346-6800
- **Mailing address:** PO BOX 70887, CLEVELAND, OH 44190-0887

## Taxonomy

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

## Other

- **Enumeration date:** 04/12/2022
- **Last updated:** 06/15/2023