Organization
DEREK L GUSTAFSON, D.D.S., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEREK LYNN GUSTAFSON D.D.S. (PRESIDENT)
(218) 743-3707
Entity
Organization
Contact information
Practice address
100 PINE TREE DR., BIGFORK, MN 56628-5596
(218) 743-3707
Mailing address
100 PINE TREE DR., PO BOX 14, BIGFORK, MN 56628-5596
(218) 743-3707
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D12387
MN
Other
Enumeration date
07/22/2008
Last updated
09/15/2009
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