Most Relevant Information
Provider Data
| NPI Number: | 1003812579 |
| Provider Name: | GARY GUSTAVSON D.D.S. |
| Entity Type: | Individual |
| Taxonomy Code: | 122300000X |
| Specialty: | Dentist |
| License Number: | 19-15094 |
Most Important Dates
| Enumeration Date: | 06/21/2005 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
64 OLD ORCHARD CTR
STE 528
SKOKIE
IL
600771440
Practice Location Phone/Fax
| Phone: | 8476753311 |
| Fax: |
Provider Mailing Location
64 OLD ORCHARD CTR
STE 528
SKOKIE
IL
600771440
Provider Mailing Phone/Fax
| Phone: | 8476753311 |
| Fax: |