Individual
DR. ALDO KOENTJORO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
206 WILMAR AVE, GRAND ISLAND, NE 68803-3559
(308) 384-7500
Mailing address
537 W 2ND ST STE 204, HASTINGS, NE 68901-7689
(402) 452-8599
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6963
NE
Other
Enumeration date
06/22/2011
Last updated
06/22/2011
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