Jared John Gustafson, D.D.S

Primary specialty

DentistTaxonomy code 122300000X

License

12927 Issued in MN

Practice address

106 3Rd Ave NW
Arlington, MN 55307-2099

Phone

(507) 964-2705

Fax

(507) 964-5848

NPI assigned

May 19, 2011

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

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dr. John D. Gustafson, D.D.S., PA

  • Dentist
  • Arlington, MN
  • NPI 1760737647
  NPD (past)

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

{
    "created_epoch": "1305763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305763200000",
    "number": "1073806303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 3RD AVE NW",
            "address_2": "PO BOX 352",
            "city": "ARLINGTON",
            "state": "MN",
            "postal_code": "553072099",
            "telephone_number": "507-964-2705",
            "fax_number": "507-964-5848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 3RD AVE NW",
            "city": "ARLINGTON",
            "state": "MN",
            "postal_code": "553072099",
            "telephone_number": "507-964-2705",
            "fax_number": "507-964-5848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "JARED",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-19",
        "last_updated": "2011-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "12927",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bethany J Diehn, LPN
• Dig Gatekeepers LLC
• Dr. John D. Gustafson, D.D.S., PA
• Forever Smiles, PLLC
• Golden Hearts, Inc.
• Mark D Hauge, MD
• Elizabeth Hermodson-Olsen, DPT
• Jon L. Hewett, D.C.
• High Island Creek Residence
• Instep Foot Clinic, P.a.

• Dentist in Arlington, MN
• Providers in Arlington, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.