Dr. Andre Widodo is a Pomona, California based Dentist who is specialized in General Practice Dentistry. He does not accept the Medicare-approved amount. Patients will be billed for the treatment. Active license number of Dr. Andre Widodo is 46152 for General Practice Dentistry in California. His current practice location is 2112 S Garey Ave Ste A, Pomona. Patients can reach him at 909-590-5600.
Dr. Andre Widodo is the primary dental care provider for patients of all ages. He is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
Complete Profile:
Dr. Andre Widodo speciality, credentials, practice address, contact phone number and fax are as below.
Patients can directly walk in or can call on the below given phone number for appointment.
Name:
Dr. Andre Widodo
Specialization:
Dentist
Gender:
Male
Credentials:
DDS
Accepts Medicare Assignment:
No
Practice Address:
2112 S Garey Ave Ste A, Pomona, California, 91766-5600
Phone:
909-590-5600
Fax:
909-590-5606
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details are as mentioned below.
NPI Number:
1508901257
NPI Enumeration Date:
20 Feb, 2007
NPI Last Update On:
25 Apr, 2022
Medical Licenses:
Doctors can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Dr. Andre Widodo are as mentioned below.
License Number
Specialization
State
Status
46152
General Practice Dentistry
California
Primary
Other Medical Identifiers:
Other legacy medical identifiers associated with Dr. Andre Widodo such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
Identifier
Type
State
Issuer
1184972135
Other
California
DENTIST
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
Address:
2112 S Garey Ave Ste A, Pomona, California
Zip:
91766-5600
Phone Number:
909-590-5600
Fax Number:
909-590-5606
Patients can reach Dr. Andre Widodo at 2112 S Garey Ave Ste A, Pomona, California or can call to book an appointment on 909-590-5600. Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 11 November, 2024.