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Dr. Andre Widodo, DDS
General Practice Dentistry in Pomona, California
NPI 1508901257

Andre Widodo is a General Practice Dentistry based in Pomona, CA and is specialized in General Practice. Andre Widodo practices in Pomona, CA and has the professional credentials of DDS. The NPI Number for Andre Widodo is 1508901257 and holds a License No. 46152 (California).

The current practice location address for Andre Widodo is 2112 S Garey Ave Ste A, Pomona, CA and can be reached out via phone at 909-590-5600 and via fax at 909-590-5606.

Location: 2112 S Garey Ave Ste A, Pomona, CA, 91766-5600
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1508901257
Provider Name
Andre Widodo
Credential
DDS
Provider Entity Type
Individual
Gender
Male
Address
2112 S Garey Ave Ste A, Pomona, CA, 91766-5600
Phone Number
909-590-5600
Fax Number
909-590-5606
Provider Enumeration Date
02/20/2007
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1184972135 01 CA DENTIST
institution
Provider Business Practice Location Address Details
Address
2112 S Garey Ave Ste A
City
Pomona
State
California
Zip
91766-5600
Phone Number
909-590-5600
Fax Number
909-590-5606
person
Provider Business Mailing Address Details
Address
2112 S Garey Ave Ste A
City
Pomona
State
California
Zip
91766-5600
Phone Number
909-590-5600
Fax Number
909-590-5606
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
General Practice
Taxonomy
1223G0001X
License No.
46152 (California)
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
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