Individual
ALEXANDER DMITRY BANKETOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4920 S 30TH ST STE 103, OMAHA, NE 68107-1656
(402) 734-4110
(402) 734-3990
Mailing address
4920 S 30TH ST STE 103, OMAHA, NE 68107-1656
(402) 734-4110
(402) 734-3990
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
13921
NC
122300000X
Dentist
Primary
8056
NE
Other
Enumeration date
07/29/2024
Last updated
01/15/2025
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