Kerin E Gustafson, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

0401416946 Issued in VA

Practice address

2204 General Booth Blvd Ste 400
Virginia Beach, VA 23454-5934

Phone

(757) 821-7397

NPI assigned

Mar 16, 2020

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

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

{
    "created_epoch": "1584316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600128000000",
    "number": "1811523459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2204 GENERAL BOOTH BLVD STE 400",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234545934",
            "telephone_number": "757-821-7397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2204 GENERAL BOOTH BLVD STE 400",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234545934",
            "telephone_number": "757-821-7397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "KERIN",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-16",
        "last_updated": "2020-09-15",
        "certification_date": "2020-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401416946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Carl Gundlach, MD
• Sandhya Gupta, MD
• Gloria Kreis Gurdziel, MD
• Jessica Anne Gurley, M.D.
• Keith B Gustafson, MD
• Klaus D Guter, D.D.S.
• Alfred Rawls Guthrie Jr., D.D.S.
• Sharyn Guthrie, L..P.C.
• Elleny Gutierrez, M.D.
• Nimsi Padua Gutierrez, NP-C

• Dentist in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Dentist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 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.

Verify at the official NPI Registry.