Gary Gustavson D.D.S.

NPI 1003812579 - Dentist - 122300000X

NPI Details
NPI 1003812579
Gender Male
Enumeration Date 06/21/2005
Last Updated 07/08/2007
Entity Type Individual
Active Over 11 years ago
Practice Location
64 OLD ORCHARD CTR
STE 528
SKOKIE IL, 60077-1440, US
Phone (847) 675-3311
Fax
Business Location
64 OLD ORCHARD CTR
STE 528
SKOKIE IL, 60077-1440, US
Phone (847) 675-3311
Fax
Toxanomy
Taxonomy Code 122300000X
License State Illinois
License Number 19-15094
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According to our database, Dr. Gary Gustavson D.D.S. NPI is 1003812579, taxonomy code is 122300000X and license number is 19-15094, license state is located at Illinois. Gary Gustavson D.D.S. physically located at 64 Old Orchard Ctr, Skokie IL, 60077-1440. NPI Number Gary Gustavson D.D.S. has the Individual type.

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1003812579 NPI number is provided on an as is basis without warranty of any kind. 1003812579 is maintained by the National Plan & Provider Enumeration System. The contents of Gary Gustavson D.D.S. are for informational purposes only.