# DR. HERAWATI TIRTADJAJA KANDOU

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1023246105
- **Gender:** F
- **Credential:** DDS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 9708 | NJ | Yes |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | 3026 | NJ | — |

## Other

- **Enumeration date:** 06/26/2009
- **Last updated:** 06/26/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3141209-01 | — | NJ |