Active NPI
Aimee Jean Gustafson, D.D.S.
- Dentist
- Polson, MT
National Provider Identifier
1205148145
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DEN-DEN-LIC-2485
- Practice address
- 5 4TH Ave E
Polson, MT 59860-2117 - Phone
- (406) 745-3525
- NPI assigned
- Jul 8, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2485 | MT | |
| Dentist | 122300000X | DEN-DEN-LIC-2485 | MT | Primary |
| Dentist | 122300000X | D12841 | MN |
Addresses
Primary practice location
5 4TH Ave E
Polson, MT 59860-2117
Mailing address
PO Box 880
Saint Ignatius, MT 59865-0880
Phone (406) 745-3525
Other practice location 1
102 1st Ave E
Polson, MT 59860-2335
Phone (406) 745-3524
Other names 1
- Aimee Jean Carr
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130524000296 | MT | Order and Referring Only - Oral Surgery | 8224276654 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D12841 | MN | MD | Dentist |
| DEN-DEN-LIC-2485 | MT | MD | Dentist |
| 2485 | MT | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1278547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710460800000",
"number": "1205148145",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 880",
"city": "SAINT IGNATIUS",
"state": "MT",
"postal_code": "598650880",
"telephone_number": "406-745-3525"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 4TH AVE E",
"city": "POLSON",
"state": "MT",
"postal_code": "598602117",
"telephone_number": "406-745-3525"
}
],
"practiceLocations": [
{
"address_1": "102 1st Ave E",
"address_purpose": "LOCATION",
"city": "Polson",
"state": "MT",
"postal_code": "598602335",
"country_code": "US",
"telephone_number": "406-745-3524",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GUSTAFSON",
"first_name": "AIMEE",
"middle_name": "JEAN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-07-08",
"last_updated": "2024-03-15",
"certification_date": "2024-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MT",
"license": "2485",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MT",
"license": "DEN-DEN-LIC-2485",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D12841",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "AIMEE",
"last_name": "CARR",
"middle_name": "JEAN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Polson, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2024; 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.