| Organization Name: | MATTHEW H. GUSTAFSSON D.D.S., INC. |
| NPI Number: | 1144559162 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MATTHEW GUSTAFSSON (OWNER/DENTIST) |
| Mailing Address: | 11253 Brockway Rd Suite 205 Truckee |
| State: | CA US |
| Postal Code: | 961613359 |
| Phone Number: | 5305509311 |
| Fax Number: | 5305508655 |
| NPI Enumeration Date: | 12/22/2009 |
| NPI Last Update Date: | 12/22/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223P0221X |
| License Number: | 55527 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | Pediatric Dentistry |
| Taxonomy Definition: | 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. |