Individual
FREDERICK GUSTAVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
10200 W MAIN ST, BELLEVILLE, IL 62223-1408
(618) 400-6725
(618) 500-6725
Mailing address
10200 W MAIN ST, BELLEVILLE, IL 62223-1408
(618) 400-6725
(618) 500-6725
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
019016600
IL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
021001098
IL
Other
Enumeration date
07/29/2006
Last updated
01/04/2024
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