Kathryn Gustafson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

70011443 Issued in WA

Practice address

19515 N Creek Pkwy Ste 212
Bothell, WA 98011-8200

Phone

(425) 486-7764

NPI assigned

Nov 27, 2023

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Norman Bolosan, DDS, PC

  • General Practice Dentistry
  • Bothell, WA
  • NPI 1871718825
  NPD (past)

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

{
    "created_epoch": "1701043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753315200000",
    "number": "1649046210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17510 W MAIN ST UNIT B104",
            "city": "MONROE",
            "state": "WA",
            "postal_code": "982721992",
            "telephone_number": "206-330-9911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19515 N CREEK PKWY STE 212",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980118200",
            "telephone_number": "425-486-7764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "KATHRYN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-27",
        "last_updated": "2025-07-24",
        "certification_date": "2025-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "70011443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mandy Rae Gulla, ND, LMP, CM
• Danelle Gundersen, RN
• Michelle Guo
• Venu Gupta
• Jody Gustafson
• Angel Gutierrez Urbina
• Laura J Guzman, INTERPRETER
• Bowhee Sohn Gwak
• Molly Sords Ha, DPT
• Ana Haberman

• Dentist in Bothell, WA
• Providers in Bothell, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2025; 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.