| Derek L Gustafson, D.d.s., P.a. | |
|
100 Pine Tree Dr. Bigfork MN 56628-5596 | |
| (218) 743-3707 | |
| Not Available |
| Full Name | Derek L Gustafson, D.d.s., P.a. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 100 Pine Tree Dr., Bigfork, Minnesota |
| Authorized Official Name and Position | Derek Lynn Gustafson (PRESIDENT) |
| Authorized Official Contact | 2187433707 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Derek L Gustafson, D.d.s., P.a. 100 Pine Tree Dr. Po Box 14 Bigfork MN 56628-5596 Ph: (218) 743-3707 | Derek L Gustafson, D.d.s., P.a. 100 Pine Tree Dr. Bigfork MN 56628-5596 Ph: (218) 743-3707 |
| NPI Number | 1902061666 |
|---|---|
| Provider Enumeration Date | 07/22/2008 |
| Last Update Date | 09/15/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902061666 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D12387 (Minnesota) | Primary |
Scenic Rivers Health Services Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 303 Main Ave, Bigfork, MN 56628 Phone: 218-361-3190 Fax: 218-743-4223 |