Dan Gustavson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

36658 Issued in CA

Practice address

1240 High St Unit 102
Auburn, CA 95603-5072

Phone

(530) 830-3333

Fax

(530) 889-9946

NPI assigned

Nov 7, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548201600000",
    "number": "1063581635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1240 HIGH ST UNIT 102",
            "city": "AUBURN",
            "state": "CA",
            "postal_code": "956035072",
            "telephone_number": "530-530-3333",
            "fax_number": "530-889-9946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1240 HIGH ST UNIT 102",
            "city": "AUBURN",
            "state": "CA",
            "postal_code": "956035072",
            "telephone_number": "530-830-3333",
            "fax_number": "530-889-9946"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1186 Roseville Pkwy Ste 120",
            "address_purpose": "LOCATION",
            "city": "Roseville",
            "state": "CA",
            "postal_code": "956781385",
            "country_code": "US",
            "telephone_number": "916-780-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUSTAVSON",
        "first_name": "DAN",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-07",
        "last_updated": "2019-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "36658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Grossman
• Zoe Grossman
• Alan F Gruenefeldt, MD
• Deanna Suyoung Guillory, DDS
• Michael Shawn Guisande
• Greyson C Guzman, RADT
• Morgan Elise Guzzi
• Kelly J Haakenson, AMFT
• Janine Mary Hackland
• R Edmond Haddad, MS DDS

• General Practice Dentistry in Auburn, CA
• Providers in Auburn, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.