Matthew H. Gustafsson D.D.S., Inc.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

55527 Issued in CA

Legal business name

MATTHEW H. GUSTAFSSON D.D.S., INC.

Practice address

11149 Brockway Rd Ste 100
Truckee, CA 96161-2212

Phone

(530) 550-9311

Fax

(530) 550-8655

NPI assigned

Dec 22, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Matthew Gustafsson, D.D.S.NPI 1568651883

Title

Owner/Dentist

Phone

(530) 550-9311

Specialties & licenses 1

Addresses

Other names 1

• Truckee Pediatric Dentistry Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Matthew H Gustafsson, D.D.S, M.S.

  • Pediatric Dentistry
  • Truckee, CA
  • NPI 1568651883
  NPD Authorized official

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

{
    "created_epoch": "1261440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740614400000",
    "number": "1144559162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11149 BROCKWAY RD STE 100",
            "city": "TRUCKEE",
            "state": "CA",
            "postal_code": "961612212",
            "telephone_number": "530-550-9311",
            "fax_number": "530-550-8655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11149 BROCKWAY RD STE 100",
            "city": "TRUCKEE",
            "state": "CA",
            "postal_code": "961612212",
            "telephone_number": "530-550-9311",
            "fax_number": "530-550-8655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTHEW H. GUSTAFSSON D.D.S., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-22",
        "last_updated": "2025-02-27",
        "certification_date": "2025-02-27",
        "status": "A",
        "authorized_official_last_name": "GUSTAFSSON",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "530-550-9311",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "55527",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Truckee Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Juanito Madraga Maravilla, D.D.S
• Tamaro Margraf, RN , IBCLC
• Lindsey Hunt Marmolejo, APRN, CPNP
• Daniel Clayton Martin, D.D.S.
• Tena Mather, RPH
• Lara A May, PHARMD, BCPS
• Peter Mayfield
• Tina Ann Mayle, MS, CPNP
• Calvin Mayo
• Sharon Mayo, C.D.

• Pediatric Dentistry in Truckee, CA
• Providers in Truckee, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2025; 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.