ALEXANDER DMITRY BANKETOV DDS
NPI 1124857164
Dentist in Omaha, NE

Q: What is Alexander Banketov's NPI number?

The NPI number for Alexander Banketov is 1124857164. It was assigned to this individual provider in the NPPES registry on July 29, 2024.

Q: What is Alexander Banketov's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Active since July 29, 2024PECOS Enrolled

4920 S 30TH ST STE 103, OMAHA, NE 68107(402) 734-4110(402) 734-3990 Get Directions Write a Review

NPPES record last updated: January 15, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Alexander Dmitry Banketov Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ALEXANDER DMITRY BANKETOV DDS (NPI 1124857164) is an individual dentist in Omaha, Nebraska, licensed in Nebraska (8056) and active in the NPI registry since July 2024. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1124857164

Entity TypeIndividualMale

Primary Taxonomy122300000X

Provider Legal NameALEXANDER DMITRY BANKETOVCredential: DDS

Location Address4920 S 30TH ST STE 103Omaha, NE 68107-1656

Mailing Address4920 S 30th St Ste 103Omaha, NE 68107-1656 · (402) 734-4110 · Fax (402) 734-3990

Phone(402) 734-4110

Fax(402) 734-3990

Sole ProprietorNo

Enumeration DateJuly 29, 2024

Last NPPES UpdateJanuary 15, 2025

NPPES CertifiedJanuary 15, 2025

✔ NPI 1124857164 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers

Taxonomy Code122300000X

Licenses✔ Licensed in NE · 8056✔ Licensed in NC · 13921

Definition

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

4920 S 30TH ST STE 103, Omaha, NE 68107

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Home State Health, Ambetter from Sunflower Health Plan, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Alexander Dmitry Banketov Dds is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 68107 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$81.20 typical visit price

range $52.69 – $160.21

Typical copayment $20.30 (range $13.17 – $40.05)

Most-billed visit code 99203

Established Patient

$66.00 typical visit price

range $16.90 – $131.25

Typical copayment $16.50 (range $4.22 – $32.81)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANGELA SALAZAR APRN

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