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Organization
HERU WIREDJA,DDS,INC
Active
Organization
HERU WIREDJA,DDS,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HERU WIREDJA DDS (PRESIDENT)
(323) 771-7551
Entity
Organization
Contact information
Practice address
6100 ATLANTIC BLVD, SUITE I, MAYWOOD, CA 90270-3131
(323) 771-7551
(323) 771-7881
Mailing address
6100 ATLANTIC BLVD, SUITE I, MAYWOOD, CA 90270-3131
(323) 771-7551
(323) 771-7881
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
33408
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33408-01
MEDICAL
CA
Enumeration date
05/21/2014
Last updated
05/21/2014
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