Koentjoro Dentistry South Pointe LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

KOENTJORO DENTISTRY SOUTH POINTE LLC

Practice address

6835 S 27TH St Ste 2
Lincoln, NE 68512-4824

Phone

(531) 220-3940

NPI assigned

Jun 17, 2021

Organization subpart

No

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

Authorized official

Name

Aldo Koentjoro

Title

Owner

Phone

(531) 220-3940

Specialties & licenses 1

Addresses

Locations

Practitioners 3

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

• Ayesha Iqbal

  • Dentist
  • Lincoln, NE
  • NPI 1033894209
  NPD
• Vy T Vu, DDS

  • General Practice Dentistry
  • Lincoln, NE
  • NPI 1275150401
  NPD
• Amanda Jean Boender, DDS

  • Dentist
  • Ashland, NE
  • NPI 1427626647

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1623888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687219200000",
    "number": "1396313011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70887",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441900887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6835 S 27TH ST STE 2",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685124824",
            "telephone_number": "531-220-3940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOENTJORO DENTISTRY SOUTH POINTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-17",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-20",
        "status": "A",
        "authorized_official_last_name": "KOENTJORO",
        "authorized_official_first_name": "ALDO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "531-220-3940"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dana Budginas Koehler
• Robert S Koel
• Rachael Koenig
• Rebecca Koenig
• Koentjoro Dentistry Lincoln LLC
• Allison Koester, PA
• Randy Truman Kohl, MD
• Rodney William Kohl, PH.D.
• Kristin K Kohler, D.D.S.
• Cody Kohles

• 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 20, 2023; 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.