MELISA SUSANTO

PUYALLUP, WA
NPI1396044517
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy1223P0221X Dentist, Pediatric Dentistry
(Licence: WA  DE60481607)
Additional Taxonomies1223G0001X Dentist, General Practice
(Licence: MI  2901020349)
Enumeration Date2011-03-28
Last Update Date2014-07-28
Business Address
-- MELISA SUSANTO DDS
16810 MERIDIAN E SUITE J104
PUYALLUP, WA 98375-9604
Phone number: 626-241-2669
Mailing Address
-- MELISA SUSANTO DDS
16810 MERIDIAN E SUITE J104
PUYALLUP, WA 98375-9604
Phone number: 626-241-2669