Little Sprouts Kids Dentistry
NPI #1205373891 in University Place, Washington
Provider Information
- NPI Number
- 1205373891
- Entity Type
- Organization
- Organization Name
- Little Sprouts Kids Dentistry
- Primary Specialty
- Clinic/Center - Dental
- Enumeration Date
- Jan 20, 2017
- Last Updated
- Jan 20, 2017
Practice Location
- Address
- 4111 BRIDGEPORT WAY W
- Address 2
- SUITE D
- City
- University Place
- State
- Washington
- ZIP Code
- 98466-4327
- Phone
- (626) 241-2669
Authorized Official
- Name
- DR. MELISA TIRTAPUTRA SUSANTO, D.D.S.
- Title
- D.D.S, M.S.
- Phone
- (626) 241-2669
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Dental — Dental |
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