Individual provider Active NPI

Michelle Christine Sue, DDS

  • Endodontics
  • Coos Bay, OR
National Provider Identifier
1316024029
Registry record updated Sep 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
DE60568617 Issued in WA
Practice address
1835 Ocean Blvd SE
Coos Bay, OR 97420-1948
Phone
(541) 267-2329
Fax
(541) 267-2335
NPI assigned
Nov 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X 49998 CA
Endodontics 1223E0200X D10753 OR
Endodontics 1223E0200X DE60568617 WA Primary

Addresses

Primary practice location

1835 Ocean Blvd SE
Coos Bay, OR 97420-1948

Mailing address

1835 Ocean Blvd SE
Coos Bay, OR 97420-1948
Phone (541) 267-2329

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160120001316 CA Order and Referring Only - DentistPractitioner - Dentist 6103129499

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D10753ORMDEndodontist
DE60568617WAMDEndodontist

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759017600000",
    "number": "1316024029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1835 OCEAN BLVD SE",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974201948",
            "telephone_number": "541-267-2329",
            "fax_number": "541-267-2335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1835 OCEAN BLVD SE",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974201948",
            "telephone_number": "541-267-2329",
            "fax_number": "541-267-2335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUE",
        "first_name": "MICHELLE",
        "middle_name": "CHRISTINE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2025-09-28",
        "certification_date": "2025-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "CA",
            "license": "49998",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "OR",
            "license": "D10753",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "WA",
            "license": "DE60568617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coos Bay, OR

Sources for this page

Verify at the official NPI Registry.