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Organization
SUSANTO DENTAL CORPORATION
Active
Organization
SUSANTO DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HANNY SUSANTO DDS (PRESIDENT)
(626) 401-0747
Entity
Organization
Contact information
Practice address
1240 N HACIENDA BLVD STE 103, LA PUENTE, CA 91744-1663
(626) 931-2525
(626) 931-2527
Mailing address
10226 OLIVE ST, TEMPLE CITY, CA 91780-3346
(626) 401-0747
(626) 401-0844
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
39482
CA
Other
Enumeration date
09/11/2007
Last updated
09/11/2007
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