Provider Demographics
NPI:1851477335
Name:GUSTOVICH, DONALD DAVID (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:DAVID
Last Name:GUSTOVICH
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:450 NORTHWEST STREET
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-1204
Mailing Address - Country:US
Mailing Address - Phone:419-483-7137
Mailing Address - Fax:419-483-6182
Practice Address - Street 1:450 NORTHWEST STREET
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-1204
Practice Address - Country:US
Practice Address - Phone:419-483-7137
Practice Address - Fax:419-483-6182
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH159921223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics