Organization
KOENTJORO DENTISTRY, DDS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALDO KOENTJORO DDS (OWNER)
(402) 972-4400
Entity
Organization
Contact information
Practice address
3225 OAK VIEW DR, OMAHA, NE 68144-5627
(402) 972-4400
(402) 330-4591
Mailing address
PO BOX 3189, SYRACUSE, NY 13220-3189
(315) 454-6000
(866) 803-4943
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6963
NE
Other
Enumeration date
12/03/2015
Last updated
12/03/2015
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