Individual
DR. POPPY WIDYASTUTI THE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
20800 SHERMAN WAY, WINNETKA, CA 91306-2707
(818) 883-2273
(818) 896-1074
Mailing address
8902 WOODMAN AVE, ARLETA, CA 91331-6401
(818) 830-7133
(818) 830-7280
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
26289
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083624423
—
CA
05
—
1538130893
—
CA
Enumeration date
05/14/2007
Last updated
04/04/2012
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