Individual
DR. DAMITA DORA WIREDJA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDA
Contact information
Practice address
6100 ATLANTIC BLVD STE I, MAYWOOD, CA 90270-3184
(323) 771-7551
(323) 771-7881
Mailing address
6100 ATLANTIC BLVD STE I, MAYWOOD, CA 90270-3184
(323) 771-7551
(323) 771-7881
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DDS106565
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DDS106565
PRIVATE
CA
Enumeration date
12/14/2021
Last updated
01/05/2022
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