Jun Soetanto, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

RES 33.79 Issued in OH

Practice address

11201 Shaker Blvd
Suite 136
Cleveland, OH 44104-3869

Phone

(216) 368-7238

NPI assigned

Jul 15, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jun a. Soetanto DMD LLC

  • General Practice Dentistry
  • Amherst, OH
  • NPI 1942955216
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1373846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373846400000",
    "number": "1154762599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11201 SHAKER BLVD",
            "address_2": "SUITE 136",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441043869",
            "telephone_number": "216-368-7238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11201 SHAKER BLVD",
            "address_2": "SUITE 136",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441043869",
            "telephone_number": "216-368-7238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOETANTO",
        "first_name": "JUN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-15",
        "last_updated": "2013-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "RES 33.79",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Simrat Kaur Sodhi
• Wai Yan Soe, MD
• Eric Soeder
• Sherry L Soeder, C.N.P.
• Neil Thomas Soehnlen, M.D.
• Robert Soffer, PH.D.
• Aijaz Ahmed Sofi, MD
• Ashley Soflkiancs, APRN, NP-C
• Margaret R Soforenko, APRN, CNP
• Marie Soha

• Dentist in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Dentist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.