Gustafson, Mark Edward
Gustafson, Mark Edward is an sole proprietor health care provider with primary practice located at 3431 Commerce Parkway Suite A, Wooster OH 44691. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Gustafson, Mark Edward can be contacted via phone (330) 264-8973.Contact Information
Primary practice address
3431 Commerce Parkway Suite A
Wooster OH 44691
Phone: (330) 264-8973
Fax: (330) 262-3072
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 30-017218 | Ohio |
| Dental Providers / General Practice | 1223G0001X | 30-01-7218 | Ohio |
Profile Details
| NPI number | 1114033214 |
|---|---|
| LBN Legal business name | Gustafson, Mark Edward |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 22nd, 2006 |
| Last updated | Sep 4th, 2009 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1114033214 | NPPES |
| Ohio | MEDICAID | 0518836 |
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