Provider Demographics
NPI:1104360478
Name:DR ROY B GUSTER DDS PC
Entity Type:Organization
Organization Name:DR ROY B GUSTER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:B
Authorized Official - Last Name:GUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-445-1009
Mailing Address - Street 1:9524 S HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-1028
Mailing Address - Country:US
Mailing Address - Phone:773-445-1009
Mailing Address - Fax:
Practice Address - Street 1:9524 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-1028
Practice Address - Country:US
Practice Address - Phone:773-445-1009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty