Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Andre Widodo, DDS

Individual provider General Practice Dentistry · NPI 1508901257

Dr. Andre Widodo, DDS is a General Practice Dentistry in Pomona, California. Works from 2 locations. Licensed in California.

Licensed in
CA
In the registry since
2007
What do these letters mean?
DDS — Doctor of Dental Surgery
A dentist. DDS and DMD are the same qualification — universities choose which title to award.

See every abbreviation used in this directory →

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Practice location Address checks out

2112 S Garey Ave Ste A
Pomona, CA 91766-5600
Phone: (909) 590-5600
Fax: (909) 590-5606
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 5562 Philadelphia St Ste 103, Chino, CA 91710-2482 — (909) 670-1100

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X · Licence 46152 (CA)

Record details

NPI number1508901257
Entity typeIndividual (Type 1)
GenderMale
Credentials DDS
Sole proprietorNo
NPI enumeratedFebruary 20, 2007
Last updated in NPPESApril 25, 2022
Certification dateApril 25, 2022
Mailing address2112 S Garey Ave Ste A, Pomona, CA 91766-5600

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