Organization
MELISSA MARKS GUSTAFSON, DDS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MELISSA MARKS GUSTAFSON DDS (OWNER)
(704) 596-0021
Entity
Organization
Contact information
Practice address
3010 BAUCOM RD, STE 200, CHARLOTTE, NC 28269-0983
(704) 596-0021
Mailing address
3010 BAUCOM RD, STE 200, CHARLOTTE, NC 28269-0983
(704) 596-0021
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7153
NC
Other
Enumeration date
11/07/2006
Last updated
01/18/2017
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