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DR. DAMITA DORA WIREDJA DDA
NPI 1740949056
Dentist in Maywood, CA

Active since December 14, 2021
6100 ATLANTIC BLVD STE I, MAYWOOD, CA 90270(323) 771-7551(323) 771-7881 Get Directions Write a Review

NPPES record last updated: January 5, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jan 5, 2022, Dec 14, 2021 (2 updates tracked since 2021).

About Dr. Damita Dora Wiredja Dda NPPES

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

DR. DAMITA DORA WIREDJA DDA (NPI 1740949056) is an individual dentist in Maywood, California, licensed in California (DDS106565) and active in the NPI registry since December 2021.

NPPES Registry Identity

NPI1740949056
Entity TypeIndividualFemale
Primary Taxonomy122300000X
Provider Legal NameDR. DAMITA DORA WIREDJACredential: DDA
Location Address6100 ATLANTIC BLVD STE IMaywood, CA 90270-3184
Mailing Address6100 Atlantic Blvd Ste IMaywood, CA 90270-3184 · (323) 771-7551 · Fax (323) 771-7881
Phone(323) 771-7551
Fax(323) 771-7881
Sole ProprietorYes
Enumeration DateDecember 14, 2021
Last NPPES UpdateJanuary 5, 20222 updates tracked since enumeration
NPPES CertifiedJanuary 5, 2022
✔ NPI 1740949056 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in CA · DDS106565
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.
6100 ATLANTIC BLVD STE I, Maywood, CA 90270
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Other Identifiers 1

OtherDDS106565CA · Private

Other Providers at the Same Location NPPES

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

HERU WIREDJA DDS
Dentist (General Practice)
6100 ATLANTIC BLVD STE I
MAYWOOD, CA 90270
Los Angeles County (323) 771-7551

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 Damita Wiredja's NPI number?

The NPI number for Damita Wiredja is 1740949056. It was assigned to this individual provider in the NPPES registry on December 14, 2021.

Where is Damita Wiredja located?

Damita Wiredja practices at 6100 Atlantic Blvd Ste I, Maywood, CA 90270. The listed phone number is (323) 771-7551.

What is Damita Wiredja's specialty?

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

When was this NPI record last updated?

The NPPES record for Damita Wiredja was last updated on January 5, 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.