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

Nicole Widjaja, DMD

Individual provider General Practice Dentistry · NPI 1063259356

Nicole Widjaja, DMD is a General Practice Dentistry in Roswell, Georgia. Licensed in Georgia. Registered with an NPI since 2024.

Licensed in
GA
In the registry since
2024
What do these letters mean?
DMD — Doctor of Dental Medicine
A dentist. Identical training and licensing to a DDS.

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Practice location Address checks out

1350 Uppr Hembree RD
Roswell, GA 30076-0928
Phone: (678) 920-7675
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X · Licence DN123505 (GA)

Record details

NPI number1063259356
Entity typeIndividual (Type 1)
GenderFemale
Credentials DMD
Sole proprietorNo
NPI enumeratedJuly 12, 2024
Last updated in NPPESJuly 12, 2024
Certification dateJuly 12, 2024
Mailing address1350 Upper Hembree Rd, Roswell, GA 30076-0928

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