WIDODO & LEE DDS A PROFESSIONAL DENTAL CORP – NPI #1245589282
Clinic/Center

WIDODO & LEE DDS A PROFESSIONAL DENTAL CORP is an AHC clinic located in POMONA, CA. NPPES has assigned the NPI number 1245589282 to WIDODO & LEE DDS A PROFESSIONAL DENTAL CORP on September 06, 2012. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 261QD0000X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Dental

Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for WIDODO & LEE DDS A PROFESSIONAL DENTAL CORP below.

NPI Profile for
WIDODO & LEE DDS A PROFESSIONAL DENTAL CORP

NPI Number
1245589282
Enumeration Date

(about 14 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
WIDODO & LEE DDS A PROFESSIONAL DENTAL CORP
Primary location
2112 S GAREY AVE STE A
POMONA, CA 91766
Phone: (909) 590-5600 Fax: (909) 590-5606
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
ANDRE WIDODO
OWNER
Phone: (909) 590-5600
Updated
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QD0000X
- Clinic/Center / Dental (Primary)		 CA 46152

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.