Organization
ANDRE WIDODO DDS A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDRE WIDODO DDS (DENTIST / OWNER)
(626) 444-7645
Entity
Organization
Contact information
Practice address
11635 VALLEY BLVD STE E, EL MONTE, CA 91732-3071
(626) 444-7645
(626) 444-7628
Mailing address
11635 VALLEY BLVD STE E, EL MONTE, CA 91732-3071
(626) 444-7645
(626) 444-7628
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
46152
CA
Other
Enumeration date
09/08/2009
Last updated
09/08/2009
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