Individual
MR. RYAN R GUSTAFSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
90 VANDENBERG DR, 66 MDS (AFMC), HANSCOM AFB, MA 01731-2104
(781) 225-6789
(781) 225-2561
Mailing address
90 VANDENBERG DR, 66 MDS (AFMC), HANSCOM AFB, MA 01731-2104
(781) 225-6789
(781) 225-2561
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
61707
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/20/2012
Last updated
01/14/2016
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