Individual
DR. MARK EDWARD GUSTAFSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3431 COMMERCE PARKWAY, SUITE A, WOOSTER, OH 44691
(330) 264-8973
(330) 262-3072
Mailing address
3431 COMMERCE PARKWAY, SUITE A, WOOSTER, OH 44691
(330) 264-8973
(330) 262-3072
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30-01-7218
OH
1223G0001X
General Practice Dentistry
30-017218
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0518836
—
OH
Enumeration date
08/22/2006
Last updated
09/04/2009
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