NPIMap

Organization Active NPI

Little Sprouts Kids Dentistry

  • Dental Clinic/Center
  • University Place, WA
National Provider Identifier
1205373891
Registry record updated Jan 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
DE 60481607 Issued in WA
Legal business name
LITTLE SPROUTS KIDS DENTISTRY
Practice address
4111 Bridgeport Way W
Suite D
University Place, WA 98466-4327
Phone
(626) 241-2669
NPI assigned
Jan 20, 2017
Last updated
Jan 20, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Melisa Tirtaputra Susanto, D.D.S.NPI 1396044517
Title
D.D.S, M.S.
Phone
(626) 241-2669

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X DE 60481607 WA Primary

Addresses

Primary practice location

4111 Bridgeport Way W
Suite D
University Place, WA 98466-4327

Mailing address

4111 Bridgeport Way W
Suite D
University Place, WA 98466-4327

National Provider Directory

National Provider Directory

Locations

4111 Bridgeport Way W
Ste D
University Place, WA 98466
Phone (626) 241-2669

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1484870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484870400000",
    "number": "1205373891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4111 BRIDGEPORT WAY W",
            "address_2": "SUITE D",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984664327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4111 BRIDGEPORT WAY W",
            "address_2": "SUITE D",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984664327",
            "telephone_number": "626-241-2669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LITTLE SPROUTS KIDS DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-20",
        "last_updated": "2017-01-20",
        "status": "A",
        "authorized_official_last_name": "SUSANTO",
        "authorized_official_first_name": "MELISA",
        "authorized_official_middle_name": "TIRTAPUTRA",
        "authorized_official_title_or_position": "D.D.S, M.S.",
        "authorized_official_telephone_number": "626-241-2669",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "WA",
            "license": "DE 60481607",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in University Place, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.