DR. JUN SOETANTO DMD
NPI 1154762599
Dentist in Cleveland, OH

Q: What is Jun Soetanto's NPI number?

The NPI number for Jun Soetanto is 1154762599. It was assigned to this individual provider in the NPPES registry on July 15, 2013.

Q: What is Jun Soetanto's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Jun Soetanto was last updated on July 15, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 15, 2013PECOS Enrolled

11201 SHAKER BLVD, SUITE 136, CLEVELAND, OH 44104(216) 368-7238 Get Directions Write a Review

NPPES record last updated: July 15, 2013. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Dr. Jun Soetanto Dmd NPPES

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

DR. JUN SOETANTO DMD (NPI 1154762599) is an individual dentist in Cleveland, Ohio, licensed in Ohio (RES 33.79) and active in the NPI registry since July 2013. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1154762599

Entity TypeIndividualMale

Primary Taxonomy122300000X

Provider Legal NameDR. JUN SOETANTOCredential: DMD

Location Address11201 SHAKER BLVD, SUITE 136Cleveland, OH 44104-3869

Mailing Address11201 Shaker Blvd, Suite 136Cleveland, OH 44104-3869 · (216) 368-7238

Phone(216) 368-7238

Sole ProprietorNo

Enumeration DateJuly 15, 2013

✔ NPI 1154762599 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers

Taxonomy Code122300000X

License✔ Licensed in OH · RES 33.79

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.

11201 SHAKER BLVD, Cleveland, OH 44104

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, 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)

Dr. Jun Soetanto Dmd 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 44104 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

$84.72 typical visit price

range $54.34 – $166.65

Typical copayment $21.18 (range $13.58 – $41.66)

Most-billed visit code 99203

Established Patient

$68.07 typical visit price

range $17.10 – $135.40

Typical copayment $17.01 (range $4.27 – $33.85)

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.

CLEVELAND DENTAL INSTITUTE LLC

Clinic/Center (Dental)

11201 SHAKER BLVD
CLEVELAND, OH 44104

Cuyahoga County (216) 368-7238

SCOTT R BARTL PAC

Physician Assistant (Medical)

11201 SHAKER BLVD, SUITE 240
CLEVELAND, OH 44104

Cuyahoga County (216) 791-0017

MABEL BURGOS

Case Manager/Care Coordinator

11201 SHAKER BLVD
CLEVELAND, OH 44104

Cuyahoga County (216) 417-8813

DIAMOND E CHERRY

Case Manager/Care Coordinator

11201 SHAKER BLVD
CLEVELAND, OH 44104

Cuyahoga County (216) 417-8813

DR. CARRIE A BASSETT D.O.

Internal Medicine

11201 SHAKER BLVD, SUITE 102A
CLEVELAND, OH 44104

Cuyahoga County (216) 721-6900

CAROL RANGE

Case Manager/Care Coordinator

11201 SHAKER BLVD
CLEVELAND, OH 44104

Cuyahoga County (216) 417-8813

MALIKIA DECTRICE CALHOUN

Case Manager/Care Coordinator

11201 SHAKER BLVD
CLEVELAND, OH 44104

Cuyahoga County (440) 752-7810

SINCERE CARE LLC

Day Training, Developmentally Disabled Services

11201 SHAKER BLVD, STE 334/336
CLEVELAND, OH 44104

Cuyahoga County (216) 347-7377

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jun Soetanto's NPI number?

The NPI number for Jun Soetanto is 1154762599. It was assigned to this individual provider in the NPPES registry on July 15, 2013.

Where is Jun Soetanto located?

Jun Soetanto practices at 11201 Shaker Blvd Suite 136, Cleveland, OH 44104. The listed phone number is (216) 368-7238.

What is Jun Soetanto's specialty?

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

Is Jun Soetanto enrolled in Medicare?

Yes. Jun Soetanto is registered in the Medicare PECOS enrollment system.

What insurance does Jun Soetanto accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, BEST Life and Blue Cross and Blue Shield of Montana and 10 other insurers list Jun Soetanto as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jun Soetanto was last updated on July 15, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.