Provider Demographics
NPI:1437557493
Name:PRIBADI, RACHMAWATI (DDS)
Entity Type:Individual
Prefix:MRS
First Name:RACHMAWATI
Middle Name:
Last Name:PRIBADI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600. E. WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LA-HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631
Mailing Address - Country:US
Mailing Address - Phone:562-691-3070
Mailing Address - Fax:562-691-7198
Practice Address - Street 1:600. E. WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LA-HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631
Practice Address - Country:US
Practice Address - Phone:562-691-3070
Practice Address - Fax:562-691-7198
Is Sole Proprietor?:No
Enumeration Date:2014-12-08
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47994122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist