| Koentjoro Dentistry South Pointe Llc | |
|
6835 S 27th St Ste 2 Lincoln NE 68512-4824 | |
| (531) 220-3940 | |
| Not Available |
| Full Name | Koentjoro Dentistry South Pointe Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 6835 S 27th St Ste 2, Lincoln, Nebraska |
| Authorized Official Name and Position | Aldo Koentjoro (OWNER) |
| Authorized Official Contact | 5312203940 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Koentjoro Dentistry South Pointe Llc Po Box 70887 Cleveland OH 44190-0887 Ph: () - | Koentjoro Dentistry South Pointe Llc 6835 S 27th St Ste 2 Lincoln NE 68512-4824 Ph: (531) 220-3940 |
| NPI Number | 1396313011 |
|---|---|
| Provider Enumeration Date | 06/17/2021 |
| Last Update Date | 06/20/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396313011 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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