Organization
FREDERICK GUSTAVE, D.D.S., PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FREDERICK GUSTAVE DDS (OWNER/ORAL SURGEON)
(618) 529-2571
Entity
Organization
Contact information
Practice address
1111 E WALNUT ST, SUITE B, CARBONDALE, IL 62901-5000
(618) 529-2571
(618) 529-2572
Mailing address
1111 E WALNUT ST, SUITE B, CARBONDALE, IL 62901-5000
(618) 529-2571
(618) 529-2572
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
019016600
IL
Other
Enumeration date
05/14/2008
Last updated
05/14/2008
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