IndividualActive
Alexander Banketov, DDS
NPI 1124857164 · Dentist · Omaha, NE
Provider details
- NPI number
- 1124857164
- Entity type
- Individual
- Primary specialty
- DentistDental Providers
- Credential
- DDS
- Sex
- Male
- Sole proprietor
- No
- License
- 13921 (NC)
Specialties & taxonomies
Dental Providers
Dental Providers
Practice location
4920 S 30th St Ste 103
Omaha, NE 68107-1656
Phone: (402) 734-4110
Fax: (402) 734-3990
Approximate (ZIP-level) locationGet directions
Mailing address
4920 S 30th St Ste 103
Omaha, NE 68107-1656
Registry dates
- Enumerated
- 2024-07-29
- Last updated
- 2025-01-15
- Certified
- 2025-01-15
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.