Provider Demographics
NPI:1205099140
Name:NUSTRA, FRANK JERALD (DDS)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:JERALD
Last Name:NUSTRA
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 1:1303 N RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-1405
Mailing Address - Country:US
Mailing Address - Phone:815-385-8040
Mailing Address - Fax:815-385-8040
Practice Address - Street 1:1303 N RICHMOND RD
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-1405
Practice Address - Country:US
Practice Address - Phone:815-385-8040
Practice Address - Fax:815-385-8040
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190136581223G0001X
IL190-136581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice