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Andre Widodo, DDS
NPI 1508901257 · on the registry since 2007
Practice
- Address
- 2112 S Garey Ave Ste A
Pomona, CA 91766 - Phone
- (909) 590-5600
- Fax
- (909) 590-5606
- Organisation at this address
- St John Community Health Center
Feras And Hisham A Medical Corporation
Widodo & Lee Dds A Professional Dental CorpInferred from a shared address, not stated in the registry. - Clinicians at this address
- 6
Additional practice sites
- 5562 Philadelphia St Ste 103, Chino, CA
Registry record
- Primary taxonomy
- General Practice Dentistry
1223G0001X
- Licence states on file
- CA
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2022-04-25
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in California