Provider Demographics
NPI:1023199577
Name:AKKOSEOGLU, ALI IHSAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:IHSAN
Last Name:AKKOSEOGLU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17132 R CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-2215
Mailing Address - Country:US
Mailing Address - Phone:402-493-3604
Mailing Address - Fax:
Practice Address - Street 1:9015 ARBOR ST
Practice Address - Street 2:SUITE 133
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2072
Practice Address - Country:US
Practice Address - Phone:402-391-0138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE51791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025036500Medicaid