Chad Michael Gustafson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6314 Issued in LA

Practice address

925 Cross Gates Blvd
Slidell, LA 70461-3920

Phone

(985) 646-1726

NPI assigned

Jun 27, 2012

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 LA

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

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

{
    "created_epoch": "1340755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373587200000",
    "number": "1306100011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 ALBERU ST",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704602543",
            "telephone_number": "985-290-9558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 CROSS GATES BLVD",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704613920",
            "telephone_number": "985-646-1726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "CHAD",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-27",
        "last_updated": "2013-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "6314",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gulf South Psychiatry, LLC
• Gulfcoast Pain Institute, a.P.M.C.
• Jennifer L. Gunderman, O.T.-CHT
• Samantha Gunn
• Tylasha Gusman
• Ronald J Gustafson, D.D.S.
• Indira Gutierrez
• Gustavo Gutnisky, M.D.
• Deatralee Guy
• Kirsten Guy, PA-C

• General Practice Dentistry in Slidell, LA
• Providers in Slidell, LA by specialty
• General Practice Dentistry in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2013; 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.