Johnathon O'Brien

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7373 Issued in NE

Practice address

3225 Oak View Dr
Omaha, NE 68144-5627

Phone

(402) 972-4400

NPI assigned

Jun 28, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

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

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 Oakview LLC

  • General Practice Dentistry
  • Omaha, NE
  • NPI 1902474638
  NPD
• Family First Dental Associates of West Point, P.C.

  • General Practice Dentistry
  • Fremont, NE
  • NPI 1669648325
  NPD (past)
• Koentjoro Dentistry, DDS, LLC

  • General Practice Dentistry
  • Omaha, NE
  • NPI 1245605153
  NPD (past)
• NBD Bel Drive LLC

  • General Practice Dentistry
  • Omaha, NE
  • NPI 1184119547
  NPD (past)

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

{
    "created_epoch": "1498608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717718400000",
    "number": "1487175634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7059 DODGE ST STE 102",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681322703",
            "telephone_number": "402-686-6186"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'BRIEN",
        "first_name": "JOHNATHON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-28",
        "last_updated": "2024-06-07",
        "certification_date": "2024-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "09395",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "101359-875",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NE",
            "license": "7373",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Achoui Nyoul
• Kelly K. Nystrom, PHARMD
• Nils A Nystrom, MD
• Daniel Columcille O'Brien, M.D.
• Dean Harvey O'Brien, DDS
• Leah K O'Brien, LIMHP
• Meghan O'Brien
• Michaela Kathleen O'Brien, MS, PLMHP
• Seara Anne O'Brien
• Sybil O'Brien

• General Practice Dentistry in Omaha, NE
• Providers in Omaha, 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 7, 2024; 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.