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DR. SANTOSO TIRTAWIDJAJA DDS
NPI 1295896850
Dentist in Los Angeles, CA

Active since December 13, 2006
1200 WEST MARTIN LUTHER KING BLVD, LOS ANGELES, CA 90037(323) 295-8306 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Santoso Tirtawidjaja Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. SANTOSO TIRTAWIDJAJA DDS (NPI 1295896850) is an individual dentist in Los Angeles, California, licensed in California (38931) and active in the NPI registry since December 2006.

NPPES Registry Identity

NPI1295896850
Entity TypeIndividualMale
Primary Taxonomy122300000X
Provider Legal NameDR. SANTOSO TIRTAWIDJAJACredential: DDS
Location Address1200 WEST MARTIN LUTHER KING BLVDLos Angeles, CA 90037
Mailing Address541 De Sales StSan Gabriel, CA 91775-2135
Phone(323) 295-8306
Sole ProprietorYes
Enumeration DateDecember 13, 2006
Last NPPES UpdateJuly 8, 2007
✔ NPI 1295896850 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in CA · 38931
Definition
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
1200 WEST MARTIN LUTHER KING BLVD, Los Angeles, CA 90037
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Montana and more.Insurance ›

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Santoso Tirtawidjaja's NPI number?

The NPI number for Santoso Tirtawidjaja is 1295896850. It was assigned to this individual provider in the NPPES registry on December 13, 2006.

Where is Santoso Tirtawidjaja located?

Santoso Tirtawidjaja practices at 1200 West Martin Luther King Blvd, Los Angeles, CA 90037. The listed phone number is (323) 295-8306.

What is Santoso Tirtawidjaja's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

What insurance does Santoso Tirtawidjaja accept?

Health plans from Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas and 6 other insurers list Santoso Tirtawidjaja as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Santoso Tirtawidjaja was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.