Provider Demographics
NPI:1518024157
Name:GUSTAFSON, CHAD ANDERS (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:ANDERS
Last Name:GUSTAFSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 ROOHR CT
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-9446
Mailing Address - Country:US
Mailing Address - Phone:252-414-8059
Mailing Address - Fax:
Practice Address - Street 1:101 RALEY BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-8352
Practice Address - Country:US
Practice Address - Phone:530-592-4688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54802122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist