Active NPI
Kerri S. Gustafson, DDS, PLLC, Dentistry for Children
- Pediatric Dentistry
- Roseville, MI
National Provider Identifier
1295347805
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- Legal business name
- KERRI S. GUSTAFSON, DDS, PLLC, DENTISTRY FOR CHILDREN
- Practice address
- 18245 E 10 Mile Rd Ste 110
Roseville, MI 48066-5807 - Phone
- (586) 585-2402
- NPI assigned
- Aug 17, 2020
- Organization subpart
- Yes
- Parent organization
- KERRI S. GUSTAFSON, DDS, PLLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Kerri S Gustafson, DDS
- Title
- DDS, Owner
- Phone
- (303) 917-2215
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | Primary |
Addresses
Primary practice location
18245 E 10 Mile Rd Ste 110
Roseville, MI 48066-5807
Mailing address
830 Cadieux Rd
Grosse Pointe, MI 48230-1232
Phone (303) 917-2215
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316910763 | Other | NPI TYPE 1 |
National Provider Directory
National Provider Directory- Part of
- Kerri S Gustafson DDS PLLC Dentistry for Children
Locations
18245 E 10 Mile Rd
Ste 110
Roseville, MI 48066
Phone (586) 585-2402
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pediatric Dentistry
- Roseville, MI
- NPI 1316910763
-
- Dentist
- Roseville, MI
- NPI 1104214733
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597622400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1597622400000",
"number": "1295347805",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "830 CADIEUX RD",
"city": "GROSSE POINTE",
"state": "MI",
"postal_code": "482301232",
"telephone_number": "303-917-2215"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18245 E 10 MILE RD STE 110",
"city": "ROSEVILLE",
"state": "MI",
"postal_code": "480665807",
"telephone_number": "586-585-2402"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KERRI S. GUSTAFSON, DDS, PLLC, DENTISTRY FOR CHILDREN",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "KERRI S. GUSTAFSON, DDS, PLLC",
"enumeration_date": "2020-08-17",
"last_updated": "2020-08-17",
"certification_date": "2020-08-17",
"status": "A",
"authorized_official_last_name": "GUSTAFSON",
"authorized_official_first_name": "KERRI",
"authorized_official_middle_name": "S",
"authorized_official_title_or_position": "DDS, OWNER",
"authorized_official_telephone_number": "303-917-2215",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "DDS"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Dentist, Pediatric Dentistry",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI TYPE 1",
"identifier": "1316910763",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Roseville, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.