Individual
ALYSSA GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
1099 N MAIN ST STE 102, SUMMERVILLE, SC 29483-7300
(843) 536-8577
Mailing address
3102 POPLAR GROVE PL, SUMMERVILLE, SC 29483-1697
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
11961
SC
Other
Enumeration date
09/17/2021
Last updated
09/17/2021
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