Lee & Widodo DDS Inc

General Practice Dentistry · Chino, CA

Organization Active NPI

NPI number 1184972135

Practice location

5562 Philadelphia St Ste 103
Chino, CA 91710
Phone
(909) 670-1100
Fax
(909) 398-0026

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NPI record

NPI
1184972135
Entity type
Organization (Type 2)
Enumeration date
August 23, 2012
Last updated
May 11, 2022
Certified
May 11, 2022
Organization subpart
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
General Practice Dentistry Primary 1223G0001X — —
Dental Clinic/Center 261QD0000X 46152 CA

Authorized official

Name
Andre Widodo, DDS
Title
Owner
Phone
(909) 670-1100

About Lee & Widodo DDS Inc

Lee & Widodo DDS Inc is a healthcare organization registered in the NPI registry with the primary taxonomy General Practice Dentistry (code 1223G0001X). The practice location is 5562 Philadelphia St Ste 103, Chino, CA 91710. The NPI number 1184972135 was assigned on August 23, 2012 and the record was last updated on May 11, 2022.

Lee & Widodo DDS Inc lists a license in the registry: #46152 (CA) for Dental Clinic/Center. License numbers are self-reported to NPPES; verify them with the state licensing board.

The authorized official for this organization is Andre Widodo, DDS, Owner.

Frequently asked questions

What is the NPI number of Lee & Widodo DDS Inc?

The NPI number is 1184972135.

What is the phone number of Lee & Widodo DDS Inc?

The phone number listed for the practice location is (909) 670-1100.

Where is Lee & Widodo DDS Inc located?

5562 Philadelphia St Ste 103, Chino, CA 91710.

What is the taxonomy code for Lee & Widodo DDS Inc?

The primary taxonomy code is 1223G0001X – General Practice Dentistry; 1 more listed above.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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