Dr. Andre Widodo, DDS

Dr. Andre Widodo is a General Practice Dentistry provider (Dentist) practicing in Pomona, CA, registered in the NPPES registry with NPI 1508901257 since 2007. The credential DDS stands for Doctor of Dental Surgery. Practices at Widodo & Lee DDS A Professional Dental Corp (listed at the same practice address in NPPES).

✓ Active NPI ✓ Valid NPI checksum

NPI	1508901257
Entity type	Individual (Type 1)
Name	Dr. Andre Widodo
Credential	DDS
Sex	Male
Practice address	2112 S GAREY AVE STE A, Pomona, CA, 91766
Phone	9095905600
Fax	9095905606
Enumeration date	2007-02-20
Last updated in NPPES	2022-04-25

Taxonomy & licenses

Taxonomy code	Specialty	Primary	License	State
1223G0001X	General Practice Dentistry	Primary	46152	CA

DDS — Doctor of Dental Surgery: A licensed dentist; DDS and DMD are equivalent dental degrees. About the DDS credential

Other identifiers

Identifier	Type	State	Issuer
1184972135	Other	CA	DENTIST

Copy-ready billing details

Provider: Andre Widodo, DDS
NPI: 1508901257
Taxonomy: 1223G0001X (General Practice Dentistry)
Address: 2112 S GAREY AVE STE A, Pomona, CA, 91766

Other providers at this practice address

NPI	Name	Type	Specialty	Location
1417031048	Jeffrey Lee	Individual	General Practice Dentistry	Pomona, CA
1245589282	Widodo & Lee DDS A Professional Dental Corp	Organization	Dental Clinic/Center	Pomona, CA

Verify this record

Cross-check NPI 1508901257 against the authoritative CMS record: view Dr. Andre Widodo on the official NPPES registry .

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.

Frequently asked questions

Is this the official NPI registry?

No. NPI Portal is a private site built on public CMS NPPES data. The official registry is npiregistry.cms.hhs.gov, operated by CMS.

What specialty is Andre Widodo?

Andre Widodo is registered in NPPES with the primary taxonomy of General Practice Dentistry. The taxonomy code describes the provider's classification and area of specialization for claims and credentialing.

Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2022-04-25.