Organization
KOENTJORO DENTISTRY SOUTH POINTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALDO KOENTJORO (OWNER)
(531) 220-3940
Entity
Organization
Contact information
Practice address
6835 S 27TH ST STE 2, LINCOLN, NE 68512-4824
(531) 220-3940
Mailing address
PO BOX 70887, CLEVELAND, OH 44190-0887
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
06/17/2021
Last updated
06/20/2023
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