Dr. Andre Widodo , DDS
Dentist - General Practice • Pomona, CA
2112 S Garey Ave Ste A
Pomona, CA 917665600
This profile restates public CMS/NPPES data; T-MedInfo gives no medical advice — consult a licensed professional, and call 911 for emergencies.
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Dr. Andre Widodo is listed in NPPES under Dentist - General Practice.
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NPI assigned on February 20, 2007; this date does not establish years in practice.
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Published CMS data list 53 Medicare Part D prescriptions, including refills, in 2024.
Source: CMS, Medicare Part D Prescribers – by Provider and Drug, 2024. Published rows only; this is not a quality measure.
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Published Part D records, 2024:
- Amoxicillin — 34 prescription fills, including refills.
- Ibuprofen — 19 prescription fills, including refills.
Source: CMS, Medicare Part D Prescribers – by Provider and Drug, 2024. Drug names come from pharmacy claims. Listing a drug here is not an endorsement or a recommendation.
See the full table · Guide: How to read Medicare Part D prescriber data
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Fewer Part D prescriptions than 60% of clinicians listed under Dentist - General Practice in Pomona, CA (2024, 23 clinicians with data). Median for this group: 72. Middle half: 32 to 142.
More Part D prescriptions than 65% of clinicians listed under Dentist - General Practice in California (2024, 6,515 clinicians with data). Median for this group: 35. Middle half: 18 to 69.
Source: CMS, Medicare Part D Prescribers – by Provider and Drug, 2024. Billing and prescribing volume is not a quality rating.
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Medicare Part D prescriptions went from 89 in 2020 to 53 in 2024.
Source: CMS, Medicare Part D Prescribers – by Provider and Drug, 2020–2024.
Practice Location & Contact Primary Location
2112 S Garey Ave Ste A
Pomona, CA 917665600
Matched by practice address or phone in NPPES. A shared address or phone does not confirm that this clinician works there.
NPPES lists 1 additional practice-address record in Chino, CA. See the list
Source: CMS NPPES NPI Registry, practice location records; release date unavailable.
Listings do not confirm current availability, employment or a shared ownership network.
What Public CMS Data Show
Dentist - General Practice: NPPES taxonomy is a reported classification, not proof of board certification.
30-day fills
53 standardized 30-day fills in 2024
CMS converts prescriptions to 30-day supplies so they can be compared. A 90-day prescription counts as about three 30-day fills.
What this does not show: 30-day fills
It is not a count of patients and not a measure of quality.
Part D drug cost
$178 in 2024
The total cost of these prescriptions in 2024, paid by Medicare drug plans, patients and other payers together.
It shows the total spending on drugs this clinician prescribed, not what any one patient paid.
What this does not show: Part D drug cost
A higher cost often reflects the type of medicines a specialty uses. It is not your out-of-pocket cost and not a measure of quality.
Source: CMS, Medicare Part D Prescribers – by Provider and Drug, 2024.
Industry payments (Open Payments)
No Open Payments records are listed for this clinician for 2019–2025.
NPI first issued
2007
The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.
What this does not show: NPI first issued
NPIs have been issued only since 2005, so this year is not necessarily when the clinician started practicing.
Source: CMS NPPES NPI Registry.
Medicare assignment not listed
CMS data do not show whether this clinician accepts Medicare assignment. This does not mean they do not accept Medicare. Ask the office.
Medicare assignment applies to Original Medicare. It does not tell you whether the clinician is in a Medicare Advantage plan's network, accepts other insurance, or is taking new patients.
Source: CMS Doctors and Clinicians; Medicare.gov, “Does your provider accept Medicare as full payment?”
No telehealth indicator
CMS shows this indicator only when recent Medicare claims include telehealth services. The clinician may still offer telehealth; ask the office.
Source: CMS, Telehealth Indicator on Medicare Care Compare (fact sheet, January 2023); CMS Doctors and Clinicians.
Compared with the same specialty in Pomona and California
Billing and prescribing volume is not a quality rating.
Medicare Part D prescriptions
Fewer Part D prescriptions than 60% of clinicians listed under Dentist - General Practice in Pomona, CA (2024, 23 clinicians with data). Median for this group: 72. Middle half: 32 to 142.
More Part D prescriptions than 65% of clinicians listed under Dentist - General Practice in California (2024, 6,515 clinicians with data). Median for this group: 35. Middle half: 18 to 69.
Part D drug cost
A lower Part D drug cost than 60% of clinicians listed under Dentist - General Practice in Pomona, CA (2024, 23 clinicians with data). Median for this group: $255. Middle half: $113 to $591.
Close to the middle for clinicians listed under Dentist - General Practice in California (2024, 6,515 clinicians with data). Median for this group: $147. Middle half: $75 to $317.
51 active clinicians are listed under Dentist - General Practice with a practice address in Pomona, CA (17,862 in California).
Addresses are self-reported to NPPES and may be out of date.
Telehealth indicator in Pomona
0% of these 51 clinicians have the CMS telehealth indicator.
0% of these 51 clinicians are listed by CMS as accepting Medicare assignment.
CMS data by year
Changes may reflect reporting, coverage or privacy limits, not changes in care quality.
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Medicare Part D prescriptions
Medicare Part D prescriptions decreased 40% from 89 in 2020 to 53 in 2024.
- 2020: 89
- 2021: 75
- 2022: 58
- 2023: 93
- 2024: 53
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30-day fills
30-day fills decreased 40% from 89 in 2020 to 53 in 2024.
- 2020: 89
- 2021: 75
- 2022: 58
- 2023: 93
- 2024: 53
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Part D drug cost
Part D drug cost went from $456 in 2020 to $178 in 2024.
- 2020: $456
- 2021: $322
- 2022: $216
- 2023: $420
- 2024: $178
Sources: CMS Medicare Part D Prescribers (2024), CMS Doctors and Clinicians, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.
Text: T-MedInfo · Report an error.
Medicare Part D Prescribing Profile & Medications
Medicare Part D prescriptions filled, including refills, in 2024.
| Brand Name | Generic Name | Prescriptions | Day Supply | Total Cost | Patients |
|---|---|---|---|---|---|
| Amoxicillin | Amoxicillin | 34 | 255 | $127.45 | 29 |
| Ibuprofen | Ibuprofen | 19 | 150 | $50.43 | 18 |
Source: CMS Part D by Provider and Drug, 2024; rows below 11 claims omitted by CMS; volume isn’t quality. Privacy limits
Specialties & License Numbers Reported to NPPES
Self-certified to NPPES: 2022-04-25NUCC Taxonomy Code: 1223G0001X
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
Additional State Medicaid & Healthcare Payer Identifiers
Secondary Practice Locations
5562 Philadelphia St Ste 103
Chino, CA 917102482
Phone: 9096701100
Clinicians Sharing This Practice Address or Phone
Clinicians sharing this NPPES address, phone or fax; a shared contact does not mean they work together.
Dentist - General Practice
Doctor of Dental Surgery
Career & Practice History
NPI enumerated February 20, 2007.
No changes to the name, practice address, taxonomy or NPI status in this record have been observed in the monthly NPPES data files from January 2017 to August 2026.
NPI Administrative Meta
Other Dentist - General Practices in Pomona
- Dr. Steve Lee, DDS
- Dr. Ahmed Soboh, DDS
- Dr. David Choi, DDS
- Dr. Dilshad Abtin, DDS
- Dr. Anthony Nguyen, DDS
- Dr. Ublester Gomez, DDS
Mailing Address
2112 S Garey Ave Ste A
Pomona, CA 917665600
Phone: 9095905600