Active NPI
Lee & Widodo DDS Inc
- General Practice Dentistry
- Chino, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- Legal business name
- LEE & WIDODO DDS INC
- Practice address
- 5562 Philadelphia St Ste 103
Chino, CA 91710 - Phone
- (909) 670-1100
- Fax
- (909) 398-0026
- NPI assigned
- Aug 23, 2012
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Andre Widodo, DDS
- Title
- Owner
- Phone
- (909) 670-1100
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | Primary | ||
| Dental Clinic/Center | 261QD0000X | 46152 | CA |
Addresses
Primary practice location
5562 Philadelphia St Ste 103
Chino, CA 91710
Mailing address
5562 Philadelphia St Ste 103
Chino, CA 91710
Phone (909) 670-1100
National Provider Directory
National Provider Directory- Tax ID family
- Lee Widodo DDS Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Dental Clinic/Center
- Pomona, CA
- NPI 1841547775
Locations
5562 Philadelphia St
Ste 103
Chino, CA 91710
Phone (909) 670-1100
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- General Practice Dentistry
- Pomona, CA
- NPI 1508901257
-
- General Practice Dentistry
- Pomona, CA
- NPI 1417031048
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1345680000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1652227200000",
"number": "1184972135",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5562 PHILADELPHIA ST STE 103",
"city": "CHINO",
"state": "CA",
"postal_code": "91710",
"telephone_number": "909-670-1100",
"fax_number": "909-398-0026"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5562 PHILADELPHIA ST STE 103",
"city": "CHINO",
"state": "CA",
"postal_code": "91710",
"telephone_number": "909-670-1100",
"fax_number": "909-398-0026"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LEE & WIDODO DDS INC",
"organizational_subpart": "NO",
"enumeration_date": "2012-08-23",
"last_updated": "2022-05-11",
"certification_date": "2022-05-11",
"status": "A",
"authorized_official_last_name": "WIDODO",
"authorized_official_first_name": "ANDRE",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "909-670-1100",
"authorized_official_credential": "DDS"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": null,
"license": null,
"primary": true
},
{
"code": "261QD0000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Dental",
"state": "CA",
"license": "46152",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 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.