# MELISSA MARKS GUSTAFSON, DDS, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285703876
- **Authorized official:** DR. MELISSA MARKS GUSTAFSON DDS (OWNER)
- **Authorized official phone:** (704) 596-0021

## Contact information

- **Practice address:** 3010 BAUCOM RD, STE 200, CHARLOTTE, NC 28269-0983
- **Practice address phone:** (704) 596-0021
- **Mailing address:** 3010 BAUCOM RD, STE 200, CHARLOTTE, NC 28269-0983
- **Mailing address phone:** (704) 596-0021

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 7153 | NC | Yes |

## Other

- **Enumeration date:** 11/07/2006
- **Last updated:** 01/18/2017