Andrew Geoffrey Widdifield, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

108329 Issued in CA

Practice address

4444 Tweedy Blvd
South Gate, CA 90280-6304

Phone

(323) 564-2444

NPI assigned

Oct 31, 2022

Last updated

Oct 31, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1667174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667174400000",
    "number": "1164139002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7521 EDINGER AVE UNIT 4601",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926470614",
            "telephone_number": "401-595-1298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4444 TWEEDY BLVD",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902806304",
            "telephone_number": "323-564-2444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDDIFIELD",
        "first_name": "ANDREW",
        "middle_name": "GEOFFREY",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-10-31",
        "last_updated": "2022-10-31",
        "certification_date": "2022-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "108329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Watson
• John Chii-Sen Wei, M.D.
• Western Dental Service, Inc
• Western Dental Services, Inc.
• Wicked Medical
• Sabina Wiederkehr, DDS
• Quennisha Williamson
• Lindsey Wolf
• Wonjoon Lee, DDS, Inc (House Dental, South Gate)
• Brianna Woo N.

• General Practice Dentistry in South Gate, CA
• Providers in South Gate, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.