Kaitlin Elizabeth Wasserman, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8021 Issued in NE

Practice address

4960 O St
Lincoln, NE 68510-1957

Phone

(402) 475-0070

NPI assigned

Jun 10, 2024

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Koentjoro Dentistry Lincoln LLC

  • General Practice Dentistry
  • Lincoln, NE
  • NPI 1912576471
  NPD

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

{
    "created_epoch": "1717977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719100800000",
    "number": "1316789324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4544 S 45TH ST",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685161119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4960 O ST",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685101957",
            "telephone_number": "402-475-0070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASSERMAN",
        "first_name": "KAITLIN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-10",
        "last_updated": "2024-06-23",
        "certification_date": "2024-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NE",
            "license": "8021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donal Washington
• Jolene Kay Washington
• Danielle Wasielewski, D.D.S.
• Elizabeth Tammie Wasserburger
• Judy Wasserman
• Rebekah Wasserstein
• Cal T Watanabe
• Hidehiko Watanabe, DDS, MS
• Mackenzie Watenpaugh
• Barbara Ann Waterman

• General Practice Dentistry in Lincoln, NE
• Providers in Lincoln, NE by specialty
• General Practice Dentistry in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2024; 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.