Melisa Susanto, DDS

Pediatric Dentistry · Puyallup, WA

Individual Active NPI

NPI number 1396044517

Practice location

16810 Meridian E
Suite J104
Puyallup, WA 98375-9604
Phone
(626) 241-2669

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NPI record

NPI
1396044517
Entity type
Individual (Type 1)
Enumeration date
March 28, 2011
Last updated
July 28, 2014
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Pediatric Dentistry Primary 1223P0221X DE60481607 WA
General Practice Dentistry 1223G0001X 2901020349 MI

About Dr. Susanto

Melisa Susanto, DDS is a healthcare provider registered in the NPI registry with the primary taxonomy Pediatric Dentistry (code 1223P0221X). The practice location is 16810 Meridian E, Suite J104, Puyallup, WA 98375-9604. The NPI number 1396044517 was assigned on March 28, 2011 and the record was last updated on July 28, 2014.

Dr. Susanto lists 2 licenses in the registry: #DE60481607 (WA) for Pediatric Dentistry; #2901020349 (MI) for General Practice Dentistry. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Melisa Susanto, DDS?

The NPI number is 1396044517.

What is the phone number of Dr. Susanto?

The phone number listed for the practice location is (626) 241-2669.

Where is Dr. Susanto located?

16810 Meridian E, Suite J104, Puyallup, WA 98375-9604.

What is the taxonomy code for Dr. Susanto?

The primary taxonomy code is 1223P0221X – Pediatric Dentistry; 1 more listed above.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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