# AGUNG PRIBADI DDS INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295830487
- **Authorized official:** AGUNG PRIBADI DDS (CEO)
- **Authorized official phone:** (562) 691-3070

## Contact information

- **Practice address:** 600 E WHITTIER BLVD, LA HABRA, CA 90631
- **Practice address phone:** (562) 691-3070
- **Practice address fax:** (562) 691-7198
- **Mailing address:** 600 E WHITTIER BLVD, LA HABRA, CA 90631
- **Mailing address phone:** (562) 691-3070
- **Mailing address fax:** (562) 691-7198

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 45519 | CA | Yes |

## Other

- **Enumeration date:** 09/13/2006
- **Last updated:** 05/22/2013