Provider Demographics
NPI:1346982147
Name:GUSFA DENTAL CLINIC, P.C.
Entity Type:Organization
Organization Name:GUSFA DENTAL CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSFA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-565-5350
Mailing Address - Street 1:24825 MICHIGAN AVE STE C
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1758
Mailing Address - Country:US
Mailing Address - Phone:313-565-5350
Mailing Address - Fax:313-565-5561
Practice Address - Street 1:24825 MICHIGAN AVE STE C
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1758
Practice Address - Country:US
Practice Address - Phone:313-565-5350
Practice Address - Fax:313-565-5561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1053318634OtherNPI