Derek L Gustafson, DDS
NPI #1356326029 in New Brighton, Minnesota
Provider Information
- NPI Number
- 1356326029
- Entity Type
- Individual
- Name
- Derek L Gustafson, DDS
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Dentist - General Practice
- Credential
- DDS
- Enumeration Date
- Dec 14, 2005
- Last Updated
- Jul 23, 2008
Practice Location
- Address
- 2467 15TH ST NW
- Address 2
- SUITE A
- City
- New Brighton
- State
- Minnesota
- ZIP Code
- 55112-5596
- Phone
- (651) 633-4883
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist |
| Dentist - General Practice — General Practice |
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