Individual
DR. CHAD MICHAEL GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
925 CROSS GATES BLVD, SLIDELL, LA 70461-3920
(985) 646-1726
Mailing address
100 ALBERU ST, SLIDELL, LA 70460-2543
(985) 290-9558
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6314
LA
Other
Enumeration date
06/27/2012
Last updated
07/12/2013
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