| Widodo & Lee Dds A Professional Dental Corp | |
|
2112 S Garey Ave Ste A Pomona CA 91766 | |
| (909) 590-5600 | |
| (909) 590-5606 |
| Full Name | Widodo & Lee Dds A Professional Dental Corp |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2112 S Garey Ave Ste A, Pomona, California |
| Authorized Official Name and Position | Andre Widodo (OWNER) |
| Authorized Official Contact | 9095905600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Widodo & Lee Dds A Professional Dental Corp 2112 S Garey Ave Ste A Pomona CA 91766 Ph: (909) 590-5600 | Widodo & Lee Dds A Professional Dental Corp 2112 S Garey Ave Ste A Pomona CA 91766 Ph: (909) 590-5600 |
| NPI Number | 1245589282 |
|---|---|
| Provider Enumeration Date | 09/06/2012 |
| Last Update Date | 09/06/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245589282 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 46152 (California) | Primary |
Larissa Gushansky, Dds Inc. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 887 E 2nd St, Suite B, Pomona, CA 91766 Phone: 909-865-8595 | |
Pravinchandra Makadia Dds Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 826 E Mission Blvd, Pomona, CA 91766 Phone: 909-622-1817 Fax: 909-622-8750 | |
Miro Itskovich, Dds Inc. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 847 Philadelphia St., Pomona, CA 91766 Phone: 909-927-4177 | |
Dr. Mehta's Grove Dental Office Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 3167 N. Garey Ave, Pomona, CA 91767 Phone: 909-596-7700 Fax: 909-392-4697 | |
Jeffrey B. Thomas, D.d.s. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 160 E Artesia St, Suite 125, Pomona, CA 91767 Phone: 909-622-1261 | |
Larissa Gushansky, Dds Inc. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 887 E 2nd St Ste D, Pomona, CA 91766 Phone: 909-865-8595 | |
Pravinchandra Makadia Dental Corporation Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 826 E Mission Blvd, Pomona, CA 91766 Phone: 909-996-6924 Fax: 909-622-8750 |