=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598337982
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARSON LEIGH GUSTAFSON DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2021
-----------------------------------------------------
Last Update Date | 08/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10037 W REMINGTON AVE
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80127-4226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-987-9109
-----------------------------------------------------
Fax | 303-984-8349
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9688 QUEENSCLIFFE DR
-----------------------------------------------------
City | HIGHLANDS RANCH
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80130-7186
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-293-7221
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DE61187483
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DEN.00205266
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------