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Individual
DR. HERAWATI TIRTADJAJA KANDOU
Active
Individual
DR. HERAWATI TIRTADJAJA KANDOU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
9708
NJ
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
3026
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3141209-01
—
NJ
Enumeration date
06/26/2009
Last updated
06/26/2009
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