Provider Demographics
NPI:1912076407
Name:GUST, JEFFREY E (DDS, MS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:E
Last Name:GUST
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-4227
Mailing Address - Country:US
Mailing Address - Phone:620-662-3255
Mailing Address - Fax:620-663-1670
Practice Address - Street 1:1000 E 30TH AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-4227
Practice Address - Country:US
Practice Address - Phone:620-662-3255
Practice Address - Fax:620-663-1670
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS603741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics