Kerri Sue Gustafson, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

2901018319 Issued in MI

Practice address

18245 E 10 Mile Rd
Suite 110
Roseville, MI 48066-5807

Phone

(586) 585-2402

Fax

(586) 445-1473

NPI assigned

Feb 8, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

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

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kgustafs@direct.dmc.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kerri S. Gustafson, DDS, PLLC, Dentistry for Children

  • Pediatric Dentistry
  • Roseville, MI
  • NPI 1295347805
  NPD Authorized official
• Jocelyn M. Robelli DDS, Ms, PLLC

  • Pediatric Dentistry
  • Roseville, MI
  • NPI 1447884069
  NPD

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

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664755200000",
    "number": "1316910763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18245 E 10 MILE RD",
            "address_2": "SUITE 110",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480665807",
            "telephone_number": "586-585-2402",
            "fax_number": "586-445-1473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18245 E 10 MILE RD",
            "address_2": "SUITE 110",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480665807",
            "telephone_number": "586-585-2402",
            "fax_number": "586-445-1473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "KERRI",
        "middle_name": "SUE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-08",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OR",
            "license": "D11710",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MI",
            "license": "2901018319",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Elizabeth Haberkorn, FNP-BC
• Tamara S Hagar, MA, LLP, LMFT, CAADC
• Haggerty Pharmacy LLC

• Pediatric Dentistry in Roseville, MI
• Providers in Roseville, MI by specialty
• Pediatric Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2022; 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.