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MALLARD CREEK FAMILY DENTISTRY
NPI 1962936104
Clinic/Center - Dental in Charlotte, NC

Active since April 14, 2017
3010 BAUCOM RD STE 200, CHARLOTTE, NC 28269(704) 596-0021(704) 599-1155 Get Directions Write a Review

NPPES record last updated: April 14, 2017. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Mallard Creek Family Dentistry NPPES

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

MALLARD CREEK FAMILY DENTISTRY (NPI 1962936104) is a healthcare organization registered as a dental in Charlotte, North Carolina and active in the NPI registry since April 2017. The organization lists Melissa Gustafson, Practice Owner, as its authorized official.

NPPES Registry Identity

NPI1962936104
Entity TypeOrganization
Primary Taxonomy261QD0000X
Legal Business NameMELISSA MARKS GUSTAFSON, DDS, PA
Location Address3010 BAUCOM RD STE 200Charlotte, NC 28269-6765
Mailing Address3010 Baucom Rd Ste 200Charlotte, NC 28269-6765 · (704) 596-0021 · Fax (704) 599-1155
Phone(704) 596-0021
Fax(704) 599-1155
Organization SubpartNo
Authorized OfficialMelissa GustafsonPractice Owner · (704) 596-0021
Enumeration DateApril 14, 2017
✔ NPI 1962936104 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · DentalAmbulatory Health Care Facilities
Taxonomy Code261QD0000X
License✔ Licensed in NC · 7153
3010 BAUCOM RD STE 200, Charlotte, NC 28269
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Other Names 1

Doing Business AsMallard Creek Family Dentistry

Other Providers at the Same Location NPPES

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

MALLARD CREEK FAMILY DENTISTRY LLP
Dentist (General Practice)
3010 BAUCOM RD STE 200
CHARLOTTE, NC 28269
Mecklenburg County (704) 596-0021

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 Melissa Marks Gustafson, Dds, PA's NPI number?

The NPI number for Melissa Marks Gustafson, Dds, PA is 1962936104. It was assigned to this organization in the NPPES registry on April 14, 2017. The provider is doing business as Mallard Creek Family Dentistry.

Where is Melissa Marks Gustafson, Dds, PA located?

Melissa Marks Gustafson, Dds, PA is located at 3010 Baucom Rd Ste 200, Charlotte, NC 28269. The listed phone number is (704) 596-0021.

What is Melissa Marks Gustafson, Dds, PA's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Dental, with taxonomy code 261QD0000X.

When was this NPI record last updated?

The NPPES record for Melissa Marks Gustafson, Dds, PA was last updated on April 14, 2017. NPI Profile syncs with the weekly NPPES data releases published by CMS.