Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dr. Damita Dora Wiredja, DDA

Individual provider Dentist · NPI 1740949056

Dr. Damita Dora Wiredja, DDA is a Dentist in Maywood, California. Practices as a sole proprietor. Licensed in California.

Licensed in
CA
In the registry since
2021
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Practice location Address checks out

6100 Atlantic Blvd Ste I
Maywood, CA 90270-3184
Phone: (323) 771-7551
Fax: (323) 771-7881
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence DDS106565 (CA)

Record details

NPI number1740949056
Entity typeIndividual (Type 1)
GenderFemale
Credentials DDA
Sole proprietorYes
NPI enumeratedDecember 14, 2021
Last updated in NPPESJanuary 5, 2022
Certification dateJanuary 5, 2022

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