MELISA SUSANTO DDS
NPI 1396044517
Dentist - Pediatric Dentistry in Puyallup, WA

Q: What is Melisa Susanto's NPI number?

The NPI number for Melisa Susanto is 1396044517. It was assigned to this individual provider in the NPPES registry on March 28, 2011.

Q: What is Melisa Susanto's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

Q: When was this NPI record last updated?

The NPPES record for Melisa Susanto was last updated on July 28, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 28, 2011PECOS Enrolled

16810 MERIDIAN E, SUITE J104, PUYALLUP, WA 98375(626) 241-2669 Get Directions Write a Review

NPPES record last updated: July 28, 2014. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Melisa Susanto Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MELISA SUSANTO DDS (NPI 1396044517) is an individual pediatric dentistry provider in Puyallup, Washington, licensed in Washington (DE60481607) and active in the NPI registry since March 2011. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1396044517

Entity TypeIndividualFemale

Primary Taxonomy1223P0221X

Provider Legal NameMELISA SUSANTOCredential: DDS

Location Address16810 MERIDIAN E, SUITE J104Puyallup, WA 98375-9604

Mailing Address16810 Meridian E, Suite J104Puyallup, WA 98375-9604 · (626) 241-2669

Phone(626) 241-2669

Sole ProprietorNo

Enumeration DateMarch 28, 2011

Last NPPES UpdateJuly 28, 2014

✔ NPI 1396044517 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers

Taxonomy Code1223P0221X

License✔ Licensed in WA · DE60481607

Definition

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.

Also ListedDentist · General PracticeTaxonomy 1223G0001X · License 2901020349 (MI)

16810 MERIDIAN E, Puyallup, WA 98375

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BEST Life, Blue Cross and Blue Shield of Alabama, Blue Cross and Blue Shield of Montana and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Melisa Susanto Dds is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 98375 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$88.29 typical visit price

range $57.27 – $172.80

Typical copayment $22.07 (range $14.31 – $43.20)

Most-billed visit code 99203

Established Patient

$71.29 typical visit price

range $18.56 – $141.11

Typical copayment $17.82 (range $4.64 – $35.27)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. PHILIP WERNER KAISER DDS

Dentist (Oral and Maxillofacial Surgery)

16810 MERIDIAN E, SUITE J107
PUYALLUP, WA 98375

Pierce County (253) 848-7777

BRIAN POLILLO D.D.S

Dentist

16810 MERIDIAN E, SUITE J107
PUYALLUP, WA 98375

Pierce County (253) 848-7777

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Melisa Susanto's NPI number?

The NPI number for Melisa Susanto is 1396044517. It was assigned to this individual provider in the NPPES registry on March 28, 2011.

Where is Melisa Susanto located?

Melisa Susanto practices at 16810 Meridian E Suite J104, Puyallup, WA 98375. The listed phone number is (626) 241-2669.

What is Melisa Susanto's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

Is Melisa Susanto enrolled in Medicare?

Yes. Melisa Susanto is registered in the Medicare PECOS enrollment system.

What insurance does Melisa Susanto accept?

Health plans from BEST Life, Blue Cross and Blue Shield of Alabama, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas and 8 other insurers list Melisa Susanto as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Melisa Susanto was last updated on July 28, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.