Individual
RYLAN GUSTAFSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
101 RALEY BLVD, SUITE 202, CHICO, CA 95928-8352
(530) 592-4688
Mailing address
101 RALEY BLVD, STE 202, CHICO, CA 95928-8352
(530) 592-4688
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
57593
CA
Other
Enumeration date
09/21/2005
Last updated
08/18/2011
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