MELISSA MARKS GUSTAFSON, DDS, PA (NPI# 1962936104) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962936104 |
| Entity Type | Organization |
| Organization Name | MELISSA MARKS GUSTAFSON, DDS, PA |
| Other Organization Name | MALLARD CREEK FAMILY DENTISTRY |
| Practice Address |
3010 Baucom Rd Ste 200 Charlotte NC 28269-6765 |
| Practice Telephone | 7045960021 |
| Practice Fax Number | 7045991155 |
| Mailing Telephone | 7045960021 |
| Mailing Fax Number | 7045991155 |
| Enumeration Date | 2017-04-14 |
| Last Update Date | 2017-04-14 |
| Authorized Official Name | DR. MELISSA GUSTAFSON (PRACTICE OWNER) |
| Authorized Official Telephone | 7045960021 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
7153 | NC | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Mallard Creek Family Dentistry | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285703876 | Melissa Marks Gustafson, Dds, Pa | Dentist | 3010 Baucom Rd, Ste 200, Charlotte, NC 28269-0983 | 2006-11-07 |
| Street Address |
3010 BAUCOM RD STE 200 |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28269-6765 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306488382 | Mallard Creek Family Dentistry LLP | Dentist | 3010 Baucom Rd Ste 200, Charlotte, NC 28269-6765 | 2019-10-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124664438 | Alluring Occupational Therapy Services, Pllc | Occupational Therapy Assistant | 3020-i Prosperity Church Rd, Ste 523, Charlotte, NC 28269 | 2019-11-21 |
| 1366085094 | Crystal R Currie | Counselor | 8824 Cliff Cameron Drive, Uint 107, Charlotte, NC 28269 | 2019-10-25 |
| 1477102879 | Apryl N. Davis | Occupational Therapy Assistant | 3020-i Prosperity Church Rd., Charlotte, NC 28269 | 2019-09-09 |
| 1730744202 | Christopher Paige | Driver | 9805 Statesville Rd., Suite 6198, Charlotte, NC 28269 | 2019-05-09 |
| 1619532892 | Krb Support Services | Prevention Professional | 11634 Oak Street, Charlotte, NC 28269 | 2019-05-03 |
| 1184186769 | Kimberly M Lynch | Local Education Agency (LEA) | 11634 Oat Street, Charlotte, NC 28269 | 2019-04-03 |
| 1356802318 | Arleen M Blythe | Physical Therapy Assistant | 1521 Bucklebury Ct, Charlotte, NC 28269 | 2019-03-30 |
| 1174089064 | Quality Behavioral Health Services, Pllc | Social Worker | 9805 Statesville Rd, # 6095, Charlotte, NC 28269 | 2019-02-15 |
| 1326517855 | Mary Frances Pickens-wilson | Behavior Technician | 4628 Quinton Lane, Charlotte, NC 28269 | 2018-11-14 |
| 1548746605 | Tiffany Michelle Graham | Counselor | 9823 Cooper Run Ln, Charlotte, NC 28269 | 2018-07-12 |
| Find all providers in zip 28269 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871109041 | Steven D Robertson Dmd, Pa | Clinic/Center | 1613 Montford Dr Ste A, Charlotte, NC 28209-3793 | 2020-09-22 |
| 1558971408 | Mid Michigan Gentle Dental | Clinic/Center | 114 S Cochran Ave, Charlotte, MI 48813-1510 | 2020-08-05 |
| 1265050504 | Hammock, Dmd & Lotakis, Dds X, Pllc | Clinic/Center | 9201 S Tryon St Ste A, Charlotte, NC 28273-4239 | 2020-07-13 |
| 1598398653 | Zammitti Gidaly Abrams Cohen & Associates Iv PC | Clinic/Center | 8631 Arbor Creek Dr Ste D1, Charlotte, NC 28269-0548 | 2020-02-18 |
| 1700447307 | Nagarani Nagarajan Dds.,pllc | Clinic/Center | 2510 Vista Drive, Suite 100, Charlotte, NC 28212 | 2019-06-25 |
| 1578021952 | Raghav Sundaresh, Dds, Pllc | Clinic/Center | 620 N Church St Ste 113, Charlotte, NC 28202-3277 | 2019-03-05 |
| 1790279628 | Bou Mjahed,dds,pllc | Clinic/Center | 328 W Carson Blvd Ste 100, Charlotte, NC 28203-4024 | 2018-06-14 |
| 1346759644 | Gregory S Reece, Dmd, Pllc | Clinic/Center | 3014 Baucom Rd Ste 100, Charlotte, NC 28269-2393 | 2017-09-29 |
| 1013457217 | Cook and Associates of North Carolina Pllc | Clinic/Center | 1836 Maryland Ave, Charlotte, NC 28209-1536 | 2017-03-07 |
| 1972958635 | Meenal H Patel Dmd Pllc | Clinic/Center | 513 Mcdonald Ave, Charlotte, NC 28203-5321 | 2016-05-02 |
| Find all providers in CHARLOTTE | ||||
Please comment or provide details below to improve the information on MELISSA MARKS GUSTAFSON, DDS, PA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.