Andre Widodo, DDS

General Practice Dentistry · Pomona, CA

Individual Active NPI

NPI number 1508901257

Practice location

2112 S Garey Ave Ste a
Pomona, CA 91766-5600
Phone
(909) 590-5600
Fax
(909) 590-5606

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NPI record

NPI
1508901257
Entity type
Individual (Type 1)
Enumeration date
February 20, 2007
Last updated
April 25, 2022
Certified
April 25, 2022
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
General Practice Dentistry Primary 1223G0001X 46152 CA

Other practice locations (1)

  • 5562 Philadelphia St Ste 103, Chino, CA 91710-2482 · (909) 670-1100

About Dr. Widodo

Andre Widodo, DDS is a healthcare provider registered in the NPI registry with the primary taxonomy General Practice Dentistry (code 1223G0001X). The practice location is 2112 S Garey Ave Ste a, Pomona, CA 91766-5600. The NPI number 1508901257 was assigned on February 20, 2007 and the record was last updated on April 25, 2022.

Dr. Widodo lists a license in the registry: #46152 (CA) for General Practice Dentistry. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Andre Widodo, DDS?

The NPI number is 1508901257.

What is the phone number of Dr. Widodo?

The phone number listed for the practice location is (909) 590-5600.

Where is Dr. Widodo located?

2112 S Garey Ave Ste a, Pomona, CA 91766-5600.

What is the taxonomy code for Dr. Widodo?

The primary taxonomy code is 1223G0001X – General Practice Dentistry.

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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