NPIMap

Organization Active NPI

Koentjoro Dentistry Dodge LLC

  • General Practice Dentistry
  • Omaha, NE
National Provider Identifier
1659013456
Registry record updated Jun 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
KOENTJORO DENTISTRY DODGE LLC
Practice address
7059 Dodge St Ste 102
Omaha, NE 68132-2703
Phone
(402) 346-6800
NPI assigned
Apr 12, 2022
Last updated
Jun 15, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2023

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

Authorized official

Name
Aldo Koentjoro
Title
Owner
Phone
(402) 346-6800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

7059 Dodge St Ste 102
Omaha, NE 68132-2703

Mailing address

PO Box 70887
Cleveland, OH 44190-0887

National Provider Directory

National Provider Directory

Locations

7059 Dodge St
Ste 102
Omaha, NE 68132
Phone (402) 346-6800

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1649721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686787200000",
    "number": "1659013456",
    "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": "7059 DODGE ST STE 102",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681322703",
            "telephone_number": "402-346-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOENTJORO DENTISTRY DODGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-12",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A",
        "authorized_official_last_name": "KOENTJORO",
        "authorized_official_first_name": "ALDO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "402-346-6800"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "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 Jun 15, 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.