Aldo Koentjoro, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6963 Issued in NE

Practice address

206 Wilmar Ave
Grand Island, NE 68803-3559

Phone

(308) 384-7500

NPI assigned

Jun 22, 2011

Sex

Male

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

Enrolled in NE

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.

• Nebraska Dental Care LLC

  • General Practice Dentistry
  • Grand Island, NE
  • NPI 1306216890
  NPD (past)

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

{
    "created_epoch": "1308700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308700800000",
    "number": "1366738924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "537 W 2ND ST STE 204",
            "city": "HASTINGS",
            "state": "NE",
            "postal_code": "689017689",
            "telephone_number": "402-452-8599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 WILMAR AVE",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688033559",
            "telephone_number": "308-384-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOENTJORO",
        "first_name": "ALDO",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-22",
        "last_updated": "2011-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NE",
            "license": "6963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nyaber Koang
• Kurt Kenneth Koch, PA-C
• Alicia Ann Kochheiser
• Richard Bruce Koefoot, M.D.
• Heather Nicole Koehlmoos, OTR/L
• Avery Kohl
• Chantal Kohl
• Rachel Sarah Kohlman, PLMHP
• Andrea Kohmetscher, APRN
• Savannah Kok

• General Practice Dentistry in Grand Island, NE
• Providers in Grand Island, 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 22, 2011; 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.