Organization
KOENTJORO DENTISTRY DODGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALDO KOENTJORO (OWNER)
(402) 346-6800
Entity
Organization
Contact information
Practice address
7059 DODGE ST STE 102, OMAHA, NE 68132-2703
(402) 346-6800
Mailing address
PO BOX 70887, CLEVELAND, OH 44190-0887
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
04/12/2022
Last updated
06/15/2023
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