Montry S. Suprono, DDS

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

56324 Issued in CA

Practice address

11092 Anderson Street
Llu School of Dentistry
Loma Linda, CA 92350-0001

Phone

(909) 558-4613

Fax

(909) 558-4192

NPI assigned

Oct 7, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1223337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1223337600000",
    "number": "1821249913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11092 ANDERSON STREET",
            "address_2": "LLU SCHOOL OF DENTISTRY",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923500001",
            "telephone_number": "909-558-4613",
            "fax_number": "909-558-4192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11092 ANDERSON STREET",
            "address_2": "LLU SCHOOL OF DENTISTRY",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923500001",
            "telephone_number": "909-558-4613",
            "fax_number": "909-558-4192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPRONO",
        "first_name": "MONTRY",
        "middle_name": "S.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-07",
        "last_updated": "2008-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "CA",
            "license": "56324",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "56324",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michel Sun, M.D., PH.D.
• Sophie Sun, MD, PHD
• Swetha Sundaram
• Eric Sung
• Hyukje Sung, MD, MA
• Aishwarya Suresh
• Brian Jonathan Sutjiadi, MD
• Jessica Jennifer Sutton, M.D.
• David Paul Suzuki, NURSE PRACTITIONER
• Yoshiaki Suzuki, MD

• Prosthodontics in Loma Linda, CA
• Providers in Loma Linda, CA by specialty
• Prosthodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2008; 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.