Melisa Susanto, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DE60481607 Issued in WA

Practice address

16810 Meridian E
Suite J104
Puyallup, WA 98375-9604

Phone

(626) 241-2669

NPI assigned

Mar 28, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1301270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406505600000",
    "number": "1396044517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16810 MERIDIAN E",
            "address_2": "SUITE J104",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983759604",
            "telephone_number": "626-241-2669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16810 MERIDIAN E",
            "address_2": "SUITE J104",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983759604",
            "telephone_number": "626-241-2669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUSANTO",
        "first_name": "MELISA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-28",
        "last_updated": "2014-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901020349",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WA",
            "license": "DE60481607",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sunshine Communities Afh LLC
• Celez Suratos, RD
• Susan Alexandria Surdez
• Surf, Sand and Sage, PLLC
• Survive to Thrive LLC
• Theodore Harris Sutarik, DPT
• Greg W. Sutherland, D.D.S., M.S., P.S.
• Belinda Sutter, M.S., CCC-SLP
• Bethany Alice Marie Sutton, LMFT
• Saly Suy

• Pediatric Dentistry in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Pediatric Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.