Winston Muditajaya, D.D.S., Inc.

Primary specialty

DentistTaxonomy code 122300000X

License

44515 Issued in CA

Legal business name

WINSTON MUDITAJAYA, D.D.S., INC.

Doing business as

Cerritos Towne Center Dentistry

Practice address

17550 Bloomfield Ave
Suite C
Cerritos, CA 90703-8584

Phone

(562) 809-4464

NPI assigned

Mar 29, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Winston Muditajaya, DDS

Title

President

Phone

(562) 809-4464

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Cerritos Towne Center Dentistry Doing business as

Locations

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213574400000",
    "number": "1699895383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17550 BLOOMFIELD AVE",
            "address_2": "SUITE C",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907038584",
            "telephone_number": "562-809-4464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17550 BLOOMFIELD AVE",
            "address_2": "SUITE C",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907038584",
            "telephone_number": "562-809-4464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINSTON MUDITAJAYA, D.D.S., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2008-06-16",
        "status": "A",
        "authorized_official_last_name": "MUDITAJAYA",
        "authorized_official_first_name": "WINSTON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "562-809-4464",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "44515",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G9356501",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cerritos Towne Center Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sammie Williams, PSY.D.
• Ryley Wilmoth
• Bernise Wilson
• Benjamin Winarko, M.D.
• Andrew Winstead
• Jennifer Nicole Winter, ED.D.
• Brock Wirtz
• Joshua Witt
• Danny Wong, O.D.
• Michael Gahao Wong, DDS

• Dentist in Cerritos, CA
• Providers in Cerritos, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2008; 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.