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1295896850
SANTOSO TIRTAWIDJAJA
LOS ANGELES, CA
NPI
1295896850
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
122300000X Dentist
(Licence: CA 38931)
Enumeration Date
2006-12-13
Last Update Date
2007-07-08
Business Address
Dr. SANTOSO TIRTAWIDJAJA DDS
1200 WEST MARTIN LUTHER KING BLVD
LOS ANGELES, CA 90037
Phone number: 323-295-8306
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Mailing Address
Dr. SANTOSO TIRTAWIDJAJA DDS
541 DE SALES ST
SAN GABRIEL, CA 91775-2135
Phone number:
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