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Organization
MELISSA MARKS GUSTAFSON, DDS, PA
Active
Organization
MELISSA MARKS GUSTAFSON, DDS, PA
Active
Other names
Mallard Creek Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MELISSA GUSTAFSON DDS (PRACTICE OWNER)
(704) 596-0021
Entity
Organization
Contact information
Practice address
3010 BAUCOM RD STE 200, CHARLOTTE, NC 28269-6765
(704) 596-0021
(704) 599-1155
Mailing address
3010 BAUCOM RD STE 200, CHARLOTTE, NC 28269-6765
(704) 596-0021
(704) 599-1155
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
7153
NC
Other
Enumeration date
04/14/2017
Last updated
04/14/2017
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