MELISA SUSANTO (NPI# 1396044517) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396044517 |
| Entity Type | Individual |
| Full Name | MELISA SUSANTO |
| Credential | DDS |
| Practice Address |
16810 Meridian E Suite J104 Puyallup WA 98375-9604 |
| Practice Telephone | 6262412669 |
| Mailing Telephone | 6262412669 |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2014-07-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223G0001X |
Dentist Specialization: General Practice |
2901020349 | MI | Dental Providers |
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
DE60481607 | WA | Dental Providers |
| Street Address |
16810 MERIDIAN E SUITE J104 |
| City | PUYALLUP |
| State | WA |
| Zip Code | 98375-9604 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013174168 | Philip Werner Kaiser | Dentist | 16810 Meridian E, Suite J107, Puyallup, WA 98375-9604 | 2008-05-16 |
| 1437686920 | Bora Kim | Dentist | 16810 Meridian E, Puyallup, WA 98375-9604 | 2017-05-16 |
| 1497177042 | Brian Polillo | Dentist | 16810 Meridian E, Suite J107, Puyallup, WA 98375-9604 | 2014-01-16 |
| 1528378700 | Jungwon Kim | Dentist | 16810 Meridian E, Puyallup, WA 98375-9604 | 2010-10-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225673817 | Cheryl Dann | Registered Nurse | 7224 Pacific Highway E, Milton, WA 98375 | 2019-11-07 |
| 1326554601 | Jasmanpreet Kaur Sidhu | Nurse's Aide | 17003 83rd Ave Cte, Puyallup, WA 98375 | 2017-12-21 |
| 1295257137 | Rafael Martin Morones IIi | Registered Nurse | 17802 87th Ave E, Puyallup, WA 98375 | 2017-07-12 |
| 1467990556 | Tessa D Parker | Massage Therapist | 17528 Meridian E Suite 207, Puyallup, WA 98375 | 2017-02-08 |
| 1144674326 | June Park | Social Worker | 9414 185th Street Ct E, Puyallup, WA 98375 | 2016-04-14 |
| 1417384348 | Washington Dental Corporation, PC | Dentist | 16810 Meridian East Suite J107, Puyallup, WA 98375 | 2013-10-10 |
| 1861825663 | L&t Chinese Medicine LLC | Acupuncturist | 16515 Meridian E., Ste. 200b, Puyallup, WA 98375 | 2013-08-15 |
| 1508110081 | Jennifer Gillings | Speech-Language Pathologist | 17418 74th Ave E, Puyallup, WA 98375 | 2012-11-05 |
| 1275887267 | Andrew Nelson Smith | Pharmacist | 14308 Meridian Ave E., Puyallup, WA 98375 | 2012-10-30 |
| 1538440714 | Zorawar Singh | Dentist | 16810 Meridian E Suite J107, Puyallup, CA 98375 | 2011-09-01 |
| Find all providers in zip 98375 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619396652 | Clara W Brannan Dds, Ps | Dentist | 11102 Sunrise Blvd E Ste 108, Puyallup, WA 98374-8846 | 2014-04-07 |
| 1760482392 | Stuart G Hersey | Dentist | 11201 88th Ave E Suite 120, Puyallup, WA 98373 | 2005-07-26 |
| 1437686920 | Bora Kim | Dentist | 16810 Meridian E, Puyallup, WA 98375-9604 | 2017-05-16 |
| 1568997351 | Katherine Romelfanger | Dentist | 9317 113th St E, Suite A, Puyallup, WA 98373-3876 | 2017-04-29 |
| 1891158861 | Kids Choice Dental Puyallup, LLC | Dentist | 9317 113th St E, Suite A, Puyallup, WA 98373-3876 | 2016-03-29 |
| 1114324795 | Washington Dental Corporation PC | Dentist | 16810 Meridian E Ste J107, Puyallup, WA 98375-9604 | 2014-11-26 |
| 1528378700 | Jungwon Kim | Dentist | 16810 Meridian E, Puyallup, WA 98375-9604 | 2010-10-20 |
| 1174791529 | Ellen Polsky | Dentist | 9317 113th St E, Suite A, Puyallup, WA 98373 | 2008-02-19 |
| 1043346851 | Kevin H Sakai | Dentist | 311 River Rd, Suite 201, Puyallup, WA 98371-4113 | 2007-02-26 |
| 1821159047 | South Hill Childrens Dentistry | Dentist | 11102 Sunrise Blvd E, Suite 108, Puyallup, WA 98374-8846 | 2006-12-12 |
| Find all providers in PUYALLUP | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.