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Organization
LEE & WIDODO DDS INC
Active
Organization
LEE & WIDODO DDS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDRE WIDODO DDS (OWNER)
(909) 670-1100
Entity
Organization
Contact information
Practice address
5562 PHILADELPHIA ST STE 103, CHINO, CA 91710
(909) 670-1100
(909) 398-0026
Mailing address
5562 PHILADELPHIA ST STE 103, CHINO, CA 91710
(909) 670-1100
(909) 398-0026
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
46152
CA
Other
Enumeration date
08/23/2012
Last updated
05/11/2022
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