Organization
LITTLE SPROUTS KIDS DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MELISA TIRTAPUTRA SUSANTO D.D.S. (D.D.S, M.S.)
(626) 241-2669
Entity
Organization
Contact information
Practice address
4111 BRIDGEPORT WAY W, SUITE D, UNIVERSITY PLACE, WA 98466-4327
(626) 241-2669
Mailing address
4111 BRIDGEPORT WAY W, SUITE D, UNIVERSITY PLACE, WA 98466-4327
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DE 60481607
WA
Other
Enumeration date
01/20/2017
Last updated
01/20/2017
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