Provider Demographics
NPI:1700944949
Name:SHUST, STEVEN JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JOSEPH
Last Name:SHUST
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 1:111 N WABASH AVE
Mailing Address - Street 2:STE 1122
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3131
Mailing Address - Country:US
Mailing Address - Phone:312-641-0610
Mailing Address - Fax:312-641-6160
Practice Address - Street 1:111 N WABASH AVE
Practice Address - Street 2:STE 1122
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3131
Practice Address - Country:US
Practice Address - Phone:312-641-0610
Practice Address - Fax:312-641-6160
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice