Individual
DR. HERAWATI TIRTADJAJA KANDOU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
35 JEFFERSON AVENUE, ELIZABETH, NJ 07201-2425
(908) 354-1188
(908) 352-7390
Mailing address
35 JEFFERSON AVENUE, ELIZABETH, NJ 07201-2425
(908) 354-1188
(908) 352-7390
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
9708
NJ
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
3026
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3141209-01
—
NJ
Enumeration date
06/26/2009
Last updated
06/26/2009
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