DR. Andre Widodo, DDS

NPI #1508901257 in Pomona, California

Provider Information

NPI Number: 1508901257
Entity Type: Individual
Name: DR. Andre Widodo, DDS
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist - General Practice
Credential: DDS
Enumeration Date: Feb 20, 2007
Last Updated: Apr 25, 2022

Practice Location

Address: 2112 S GAREY AVE STE A
City: Pomona
State: California
ZIP Code: 91766-5600
Phone: (909) 590-5600

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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