Healthcare Provider Details

I. General information

NPI: 1346982147
Provider Name (Legal Business Name): GUSFA DENTAL CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22731 NEWMAN ST STE 210
DEARBORN MI
48124-2023
US

IV. Provider business mailing address

22731 NEWMAN ST STE 210
DEARBORN MI
48124-2023
US

V. Phone/Fax

Practice location:
  • Phone: 313-565-5350
  • Fax: 313-565-5561
Mailing address:
  • Phone: 313-565-5350
  • Fax: 313-565-5561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN GUSFA
Title or Position: PRESIDENT
Credential: DDS
Phone: 313-565-5350