Susanto Dental Corporation

Primary specialty

DentistTaxonomy code 122300000X

License

39482 Issued in CA

Legal business name

SUSANTO DENTAL CORPORATION

Practice address

1240 N Hacienda Blvd Ste 103
La Puente, CA 91744-1663

Phone

(626) 931-2525

Fax

(626) 931-2527

NPI assigned

Sep 11, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Hanny Susanto, DDS

Title

President

Phone

(626) 401-0747

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1189468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189468800000",
    "number": "1609061720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10226 OLIVE ST",
            "city": "TEMPLE CITY",
            "state": "CA",
            "postal_code": "917803346",
            "telephone_number": "626-401-0747",
            "fax_number": "626-401-0844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1240 N HACIENDA BLVD STE 103",
            "city": "LA PUENTE",
            "state": "CA",
            "postal_code": "917441663",
            "telephone_number": "626-931-2525",
            "fax_number": "626-931-2527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSANTO DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-11",
        "last_updated": "2007-09-11",
        "status": "A",
        "authorized_official_last_name": "SUSANTO",
        "authorized_official_first_name": "HANNY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "626-401-0747",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "39482",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alivia Jane Stoddard, DMD
• Alexa Stubblefield, PSS
• David Sun
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• Sunkist Multispecialty Medical Clinic, Inc
• Brenda Ann Tabone, NP
• Andres Tafolla
• San Khoen Tan, D.D.S
• Nico Tank
• Hailey Tardif

• Dentist in La Puente, CA
• Providers in La Puente, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2007; 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.