# HERAWATI T KANDOU DDS PA

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** HERAWATI T KANDOU DDS PA
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1245499847
- **Legal business name:** HERAWATI T KANDOU DDS PA
- **Authorized official:** DR. HERAWATI T KANDOU DDS (PRESIDENT ORTHODONTIST)
- **Authorized official phone:** (732) 560-5988

## Contact information

- **Practice address:** 163 WASHINGTON VALLEY RD STE 106, WASHINGTON VALLEY OFFICE PARK, WARREN, NJ 07059-7181
- **Practice address phone:** (732) 560-5988
- **Practice address fax:** (732) 563-6999
- **Mailing address:** 163 WASHINGTON VALLEY RD STE 106, WASHINGTON VALLEY OFFICE PARK, WARREN, NJ 07059-7181
- **Mailing address phone:** (732) 560-5988
- **Mailing address fax:** (732) 563-6999

## Taxonomy

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

## Other

- **Enumeration date:** 06/09/2008
- **Last updated:** 06/09/2008