NPIMap

Organization Active NPI

Melissa Marks Gustafson, DDS, PA

  • General Practice Dentistry
  • Charlotte, NC
National Provider Identifier
1285703876
Registry record updated Jan 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
7153 Issued in NC
Legal business name
MELISSA MARKS GUSTAFSON, DDS, PA
Practice address
3010 Baucom Rd
Ste 200
Charlotte, NC 28269-0983
Phone
(704) 596-0021
NPI assigned
Nov 7, 2006
Last updated
Jan 18, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2017

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

Authorized official

Name
Dr. Melissa Marks Gustafson, DDSNPI 1508935180
Title
Owner
Phone
(704) 596-0021

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 7153 NC Primary

Addresses

Primary practice location

3010 Baucom Rd
Ste 200
Charlotte, NC 28269-0983

Mailing address

3010 Baucom Rd
Ste 200
Charlotte, NC 28269-0983
Phone (704) 596-0021

National Provider Directory

National Provider Directory
Tax ID family
Mallard Creek Family Dentistry2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484697600000",
    "number": "1285703876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3010 BAUCOM RD",
            "address_2": "STE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282690983",
            "telephone_number": "704-596-0021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3010 BAUCOM RD",
            "address_2": "STE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282690983",
            "telephone_number": "704-596-0021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MELISSA MARKS GUSTAFSON, DDS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2017-01-18",
        "status": "A",
        "authorized_official_last_name": "GUSTAFSON",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "MARKS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-596-0021",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "7153",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2017; 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.