KERRI S. GUSTAFSON, DDS, PLLC, DENTISTRY FOR CHILDREN (NPI# 1295347805) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295347805 |
| Entity Type | Organization |
| Organization Name | KERRI S. GUSTAFSON, DDS, PLLC, DENTISTRY FOR CHILDREN |
| Practice Address |
18245 E 10 Mile Rd Ste 110 Roseville MI 48066-5807 |
| Mailing Address |
830 Cadieux Rd Grosse Pointe MI 48230-1232 |
| Practice Telephone | 5865852402 |
| Mailing Telephone | 3039172215 |
| Enumeration Date | 2020-08-17 |
| Last Update Date | 2020-08-17 |
| Authorized Official Name | DR. KERRI S GUSTAFSON (DDS, OWNER) |
| Authorized Official Telephone | 3039172215 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | Y |
| Parent Organization Name | KERRI S. GUSTAFSON, DDS, PLLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NPI TYPE 1 | 1316910763 | 01 |
| Street Address |
18245 E 10 MILE RD STE 110 |
| City | ROSEVILLE |
| State | MI |
| Zip Code | 48066-5807 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447884069 | Jocelyn M. Robelli Dds, Ms, Pllc | Dentist | 18245 E 10 Mile Rd Ste 110, Roseville, MI 48066-5807 | 2020-02-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437761400 | Louay Mansour Dds PC | Dentist | 27845 Gratiot Avenue, Roseville, MI 48066 | 2020-08-20 |
| 1558911842 | Jomy Jose | Nurse Practitioner | 25719 Salem St, Roseville, MI 48066 | 2019-09-18 |
| 1053963033 | Convenient Rv PC | Dentist | 19551 E. 10 Mile Rd, Roseville, MI 48066 | 2019-07-10 |
| 1063914539 | Colleen Meriweather | Registered Nurse | 27300 Spruce, Rosevilel, MI 48066 | 2018-03-01 |
| 1326565789 | Renee Suzette Hoelzeman | Nurse Practitioner | 18472 Meier St, Roseville, MI 48066 | 2017-08-27 |
| 1225561400 | Eugenia Dillard | Counselor | 28351 Gratiot Ave., Suite 3, Roseville, MI 48066 | 2017-04-05 |
| 1932651338 | Julie Plichota | Physical Therapist | 31120 Gratiot Ave, Roseville, MI 48066 | 2016-11-01 |
| 1699221325 | Jaquenta Glasker | Technician, Other | 26778 Rosewood, Roseville, MI 48066 | 2016-09-01 |
| 1609296144 | Peter Jajou | Dermatology | 18285 E 10 Mile Rd Ste 130, Roseville, MI 48066 | 2014-04-23 |
| 1619393899 | Katherine Michelle Johnson | Obstetrics & Gynecology | 29751 Little Mack Ave Ste B, Roseville, MI 48066 | 2014-03-11 |
| Find all providers in zip 48066 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447884069 | Jocelyn M. Robelli Dds, Ms, Pllc | Dentist | 18245 E 10 Mile Rd Ste 110, Roseville, MI 48066-5807 | 2020-02-24 |
| 1205113859 | Richard Knight | Dentist | 2520 Douglas Blvd Ste 130, Roseville, CA 95661-3993 | 2011-11-10 |
| 1982890331 | Jack Lowell Moore | Dentist | 700 Sunrise Avenue, Suite C, Roseville, CA 95661-4561 | 2007-09-19 |
| 1780750539 | Dental Specialists of Minnesota, Pllc | Dentist | 1835 County Road C-west, Suite 200, Roseville, MN 55113-1343 | 2006-11-24 |
| 1366448524 | Linda Patricia Rafferty | Dentist | 2520 Douglas Blvd, Ste 130, Roseville, CA 95661-3993 | 2005-06-22 |
| 1033639463 | Crutchfield Pediatric Dental Group | Dentist | 1253 Pleasant Grove Blvd Ste 190, Roseville, CA 95678-6983 | 2017-06-27 |
| 1336696426 | Dmitriy Pivnik Dds Inc | Dentist | 721 Pleasant Grove Blvd Ste 150, Roseville, CA 95678-6181 | 2016-09-06 |
| 1275991721 | Dmitriy Pivnik | Dentist | 721 Pleasant Grove Blvd Ste 150, Roseville, CA 95678-6181 | 2016-01-29 |
| 1760710834 | Cassandra Krupansky | Dentist | 2520 Douglas Blvd, Suite 130, Roseville, CA 95661-3992 | 2009-11-30 |
| 1326242348 | Kathryn Ann Moore | Dentist | 700 Sunrise Ave, #c, Roseville, CA 95661 | 2007-06-13 |
| Find all providers in ROSEVILLE | ||||
Please comment or provide details below to improve the information on KERRI S. GUSTAFSON, DDS, PLLC, DENTISTRY FOR CHILDREN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.