Andre Widodo is a General Practice in Pomona, California. Andre Widodo practices all healthcare services and medical treatments related to General Practice. The NPI Number for Andre Widodo is 1508901257. The last update date is 2022-04-25.
Andre Widodo's current location address is 2112 S Garey Ave Ste A, Pomona, California. You can contact this provider via phone number 9095905600 and fax number 9095905606. The mailing address for Andre Widodo is 2112 S Garey Ave Ste A, Pomona, California. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Andre Widodo |
|---|---|
| Address | 2112 S Garey Ave Ste A, Pomona, California |
| Phone Number | 9095905600 |
| Fax Number | 9095905606 |
| Sole Proprietor | N |
| Credentials | DDS |
NPI Number Detail
| NPI Number | 1508901257 |
|---|---|
| Provider Enumeration Date | 2007-02-20 |
| Last Updated Date | 2022-04-25 |
Provider Mailing Address Detail
| Address | 2112 S Garey Ave Ste A |
|---|---|
| City | Pomona |
| State | California (CA) |
| Post Code | 917665600 |
| Phone Number | 9095905600 |
| Fax Number | 9095905606 |
Provider's Primary Taxonomy Detail
| Speciality | General Practice |
|---|---|
| Taxonomy | 1223G0001X |
| Licence No | 46152 |
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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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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 1184972135 | CA | DENTIST |
Post Comment/ Review Below
What is the unique 10-digit identifier code issued to Andre Widodo by the Centers for Medicare & Medicaid Services?
The Andre Widodo has been assigned the NPI (National Provider Identifier) 1508901257 by the CMS (Centers for Medicare & Medicaid Services). This 10-digit code serves as a unique identification number for healthcare providers.
Could you please share the complete physical address where Andre Widodo is geographically located?
The Andre Widodo is physically situated at the following location: 2112 S Garey Ave Ste A, Pomona, CA, 917665600.
What is Andre Widodo's area of specialization, and what is the corresponding taxonomy classification code for this field of practice?
The specialized area of practice for Andre Widodo is General Practice, and the taxonomy code that categorizes this field of expertise is 1223G0001X.
On what date did the Centers for Medicare & Medicaid Services issue the 1508901257 to Andre Widodo?
The Andre Widodo received its 1508901257 assignment from the Centers for Medicare & Medicaid Services on 2007-02-20.
When was the information regarding Andre Widodo, such as address, specialty, and other details, most recently verified or confirmed to be accurate?
The information pertaining to Andre Widodo, including its address, specialty, and other relevant details, was most recently verified or confirmed to be accurate on 2022-04-25.