1. Home
  2. Directory
  3. California
  4. Pomona
  5. Dentist
  6. NPI Profile

DR. ANDRE WIDODO DDS
NPI 1508901257
Dentist - General Practice in Pomona, CA

Active since February 20, 2007
2112 S GAREY AVE STE A, POMONA, CA 91766(909) 590-5600(909) 590-5606 Get Directions Write a Review

NPPES record last updated: April 25, 2022. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Apr 25, 2022, Apr 21, 2022, Apr 14, 2022 (3 updates tracked since 2022).

About Dr. Andre Widodo Dds NPPES

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

DR. ANDRE WIDODO DDS (NPI 1508901257) is an individual general practice provider in Pomona, California, licensed in California (46152) and active in the NPI registry since February 2007. He maintains a secondary practice location in Chino.

NPPES Registry Identity

NPI1508901257
Entity TypeIndividualMale
Primary Taxonomy1223G0001X
Provider Legal NameDR. ANDRE WIDODOCredential: DDS
Location Address2112 S GAREY AVE STE APomona, CA 91766-5600
Mailing Address2112 S Garey Ave Ste APomona, CA 91766-5600 · (909) 590-5600 · Fax (909) 590-5606
Phone(909) 590-5600
Fax(909) 590-5606
Sole ProprietorNo
Enumeration DateFebruary 20, 2007
Last NPPES UpdateApril 25, 20223 updates tracked since enumeration
NPPES CertifiedApril 25, 2022
✔ NPI 1508901257 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in CA · 46152
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
2112 S GAREY AVE STE A, Pomona, CA 91766
Open in Google Maps ↗

Secondary Practice Location 1

Location 15562 Philadelphia St Ste 103Chino, CA 91710-2482 · Phone (909) 670-1100 · Fax (909) 398-0026

Other Identifiers 1

Other1184972135CA · Dentist

Accepted Insurance

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

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

WIDODO & LEE DDS A PROFESSIONAL DENTAL CORP
Clinic/Center (Dental)
2112 S GAREY AVE STE A
POMONA, CA 91766
Los Angeles County (909) 590-5600
DR. JEFFREY LEE DDS
Dentist (General Practice)
2112 S GAREY AVE STE A
POMONA, CA 91766
Los Angeles County (909) 590-5600

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 Andre Widodo's NPI number?

The NPI number for Andre Widodo is 1508901257. It was assigned to this individual provider in the NPPES registry on February 20, 2007.

Where is Andre Widodo located?

Andre Widodo practices at 2112 S Garey Ave Ste A, Pomona, CA 91766. The listed phone number is (909) 590-5600.

What is Andre Widodo's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

What insurance does Andre Widodo accept?

Health plans from Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and Florida Combined Life and 2 other insurers list Andre Widodo 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 Andre Widodo was last updated on April 25, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.