Derek L Gustafson in New Brighton - Dentist
Derek L Gustafson - NPI 1356326029
Derek L Gustafson is a Dentist in New Brighton, Minnesota. Derek L Gustafson practices all healthcare services and medical treatments related to Dentist. The NPI Number for Derek L Gustafson is 1356326029. The last update date is 2008-07-23.
Derek L Gustafson's current location address is 2467 15th St Nw, New Brighton, Minnesota. You can contact this provider via phone number 6516334883 and fax number 6516334998. The mailing address for Derek L Gustafson is 2467 15th St Nw, New Brighton, Minnesota. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Derek L Gustafson |
|---|---|
| Address | 2467 15th St Nw, New Brighton, Minnesota |
| Phone Number | 6516334883 |
| Fax Number | 6516334998 |
| Sole Proprietor | Y |
| Credentials | DDS |
NPI Number Detail
| NPI Number | 1356326029 |
|---|---|
| Provider Enumeration Date | 2005-12-14 |
| Last Updated Date | 2008-07-23 |
Provider Mailing Address Detail
| Address | 2467 15th St Nw |
|---|---|
| City | New Brighton |
| State | Minnesota (MN) |
| Post Code | 551125596 |
| Phone Number | 6516334883 |
| Fax Number | 6516334998 |
Provider's Primary Taxonomy Detail
| Speciality | Dentist |
|---|---|
| Taxonomy | 122300000X |
| Licence No | DD2591 |
|
Definition: A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: denti |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| DD2591 | DENTAL LICENSE | ||
| 12387 | MN | LICENSE |
Post Comment/ Review Below
Could you please provide the complete street address where Derek L Gustafson is physically located?
The Derek L Gustafson is physically situated at the following address: 2467 15Th St Nw, New Brighton, MN, 551125596.
What is the Derek L Gustafson's area of specialization and corresponding taxonomy classification?
The Derek L Gustafson's specialty field is Dentist, and it falls under the taxonomy code 122300000X, which categorizes healthcare providers based on their specialties.
What is Derek L Gustafson's area of specialization, and what is the corresponding taxonomy classification code for this field of practice?
The specialized area of practice for Derek L Gustafson is Dentist, and the taxonomy code that categorizes this field of expertise is 122300000X.
When did the Derek L Gustafson receive its 1356326029?
The Derek L Gustafson was issued its 1356326029 on 2005-12-14, which is the date when the organization was assigned this unique identifier.
On what date did the Derek L Gustafson receive its 1356326029 assignment from the Centers for Medicare & Medicaid Services?
The Derek L Gustafson was assigned its 1356326029 by the Centers for Medicare & Medicaid Services on 2005-12-14.
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