Provider Demographics
NPI:1245218320
Name:GUSTKE, CARL JEFFRIES (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:JEFFRIES
Last Name:GUSTKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-1828
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:COMDT (CG-1122) U.S. COAST GUARD
Practice Address - Street 2:2100 2ND ST. SW, SUITE 5314
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20593
Practice Address - Country:US
Practice Address - Phone:202-267-0801
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027832L1223P0300X
WI4328-0151223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223P0300XDental ProvidersDentistPeriodontics