Organization
KERRI S. GUSTAFSON, DDS, PLLC, DENTISTRY FOR CHILDREN
Active
Parent organization
KERRI S. GUSTAFSON, DDS, PLLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
KERRI S. GUSTAFSON, DDS, PLLC
Authorized official
DR. KERRI S GUSTAFSON DDS (DDS, OWNER)
(303) 917-2215
Entity
Organization
Contact information
Practice address
18245 E 10 MILE RD STE 110, ROSEVILLE, MI 48066-5807
(586) 585-2402
Mailing address
830 CADIEUX RD, GROSSE POINTE, MI 48230-1232
(303) 917-2215
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1316910763
NPI TYPE 1
—
Enumeration date
08/17/2020
Last updated
08/17/2020
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