Individual
DR. GARY GUSTAVSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
64 OLD ORCHARD CTR, STE 528, SKOKIE, IL 60077-1440
(847) 675-3311
Mailing address
64 OLD ORCHARD CTR, STE 528, SKOKIE, IL 60077-1440
(847) 675-3311
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
19-15094
IL
Other
Enumeration date
06/21/2005
Last updated
07/08/2007
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