Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Melissa Marks Gustafson, DDS, PA

Organization Dental Clinic/Center · NPI 1962936104

Melissa Marks Gustafson, DDS, PA is a Dental Clinic/Center in Charlotte, North Carolina. Licensed in North Carolina. Registered with an NPI since 2017.

Licensed in
NC
In the registry since
2017
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

3010 Baucom Rd Ste 200
Charlotte, NC 28269-6765
Phone: (704) 596-0021
Fax: (704) 599-1155
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dental Clinic/Center (primary) Taxonomy 261QD0000X · Licence 7153 (NC)

Record details

NPI number1962936104
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Melissa Gustafson — Practice Owner · (704) 596-0021
Other names Mallard Creek Family Dentistry
NPI enumeratedApril 14, 2017
Last updated in NPPESApril 14, 2017
Mailing address3010 Baucom Rd Ste 200, Charlotte, NC 28269-6765

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