Organization
WIDODO & LEE DDS A PROFESSIONAL DENTAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDRE WIDODO DDS (OWNER)
(909) 590-5600
Entity
Organization
Contact information
Practice address
2112 S GAREY AVE STE A, POMONA, CA 91766
(909) 590-5600
(909) 590-5606
Mailing address
2112 S GAREY AVE STE A, POMONA, CA 91766
(909) 590-5600
(909) 590-5606
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
46152
CA
Other
Enumeration date
09/06/2012
Last updated
09/06/2012
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