Widodo, Andre

Widodo, Andre is an individual health care provider with primary practice located at 2112 S Garey Ave Ste A , Pomona CA 91766-5600. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Widodo, Andre can be contacted via phone (909) 590-5600.

Contact Information

Primary practice address
2112 S Garey Ave Ste A Pomona CA 91766-5600
Phone: (909) 590-5600
Fax: (909) 590-5606
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 46152 California

Profile Details

NPI number 1508901257
LBN Legal business name Widodo, Andre
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 20th, 2007
Last updated Apr 25th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508901257 NPPES
California Other 1184972135 DENTIST

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