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DEREK L GUSTAFSON DDS
NPI 1356326029
Dentist - General Practice in New Brighton, MN

Active since December 14, 2005
2467 15TH ST NW, SUITE A, NEW BRIGHTON, MN 55112(651) 633-4883(651) 633-4998 Get Directions Write a Review

NPPES record last updated: July 23, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Derek L Gustafson Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DEREK L GUSTAFSON DDS (NPI 1356326029) is an individual general practice provider in New Brighton, Minnesota, licensed in Minnesota (12387) and active in the NPI registry since December 2005.

NPPES Registry Identity

NPI1356326029
Entity TypeIndividualMale
Primary Taxonomy1223G0001X
Provider Legal NameDEREK L GUSTAFSONCredential: DDS
Location Address2467 15TH ST NW, SUITE ANew Brighton, MN 55112-5596
Mailing Address2467 15th St Nw, Suite ANew Brighton, MN 55112-5596 · (651) 633-4883 · Fax (651) 633-4998
Phone(651) 633-4883
Fax(651) 633-4998
Sole ProprietorYes
Enumeration DateDecember 14, 2005
Last NPPES UpdateJuly 23, 2008
✔ NPI 1356326029 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in MN · 12387
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
Also ListedDentistTaxonomy 122300000X · License DD2591 (NM)
2467 15TH ST NW, New Brighton, MN 55112
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Other Identifiers 2

OtherDD2591Dental License
Other12387MN · License

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JEFFREY LINN BENSON D.D.S.
Dentist (General Practice)
2467 15TH ST NW, SUITE A
NEW BRIGHTON, MN 55112
Ramsey County (651) 633-4883
DR. KRISTINE MARIE GOULET D.D.S.
Dentist
2467 15TH ST NW, SUITE A
NEW BRIGHTON, MN 55112
Ramsey County (651) 633-4883
DR. STEVEN MICHAEL PETRY DC
Chiropractor
2467 15TH ST NW
NEW BRIGHTON, MN 55112
Ramsey County (651) 633-6212

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Derek Gustafson's NPI number?

The NPI number for Derek Gustafson is 1356326029. It was assigned to this individual provider in the NPPES registry on December 14, 2005.

Where is Derek Gustafson located?

Derek Gustafson practices at 2467 15th St NW Suite A, New Brighton, MN 55112. The listed phone number is (651) 633-4883.

What is Derek Gustafson's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Derek Gustafson was last updated on July 23, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.