Organization
MELISSA MARKS GUSTAFSON, DDS, PA
Active
Other names
Mallard Creek Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MELISSA GUSTAFSON DDS (PRACTICE OWNER)
(704) 596-0021
Entity
Organization
Contact information
Practice address
3010 BAUCOM RD STE 200, CHARLOTTE, NC 28269-6765
(704) 596-0021
(704) 599-1155
Mailing address
3010 BAUCOM RD STE 200, CHARLOTTE, NC 28269-6765
(704) 596-0021
(704) 599-1155
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
7153
NC
Other
Enumeration date
04/14/2017
Last updated
04/14/2017
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