NPIMap

Organization Active NPI

Koentjoro Dentistry, DDS, LLC

  • General Practice Dentistry
  • Omaha, NE
National Provider Identifier
1245605153
Registry record updated Dec 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
6963 Issued in NE
Legal business name
KOENTJORO DENTISTRY, DDS, LLC
Practice address
3225 Oak View Dr
Omaha, NE 68144-5627
Phone
(402) 972-4400
Fax
(402) 330-4591
NPI assigned
Dec 3, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2015

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

Authorized official

Name
Aldo Koentjoro, DDS
Title
Owner
Phone
(402) 972-4400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 6963 NE Primary

Addresses

Primary practice location

3225 Oak View Dr
Omaha, NE 68144-5627

Mailing address

PO Box 3189
Syracuse, NY 13220-3189
Phone (315) 454-6000

National Provider Directory

National Provider Directory

Locations

3225 Oak View Dr
Omaha, NE 68144
Phone (402) 915-5501

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1449100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449100800000",
    "number": "1245605153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3189",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132203189",
            "telephone_number": "315-454-6000",
            "fax_number": "866-803-4943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3225 OAK VIEW DR",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681445627",
            "telephone_number": "402-972-4400",
            "fax_number": "402-330-4591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOENTJORO DENTISTRY, DDS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-03",
        "last_updated": "2015-12-03",
        "status": "A",
        "authorized_official_last_name": "KOENTJORO",
        "authorized_official_first_name": "ALDO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "402-972-4400",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NE",
            "license": "6963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.