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Provider Information for 1770796195



DR. ROY GUSTER D.D.S.

Gender: MALE

Individual NPI: 1770796195

Calendar Last Updated: 2007-07-08

Details

Name Value
NPI 1770796195
Enumeration Date 2007-05-08
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address PO BOX 436969
CHICAGO, IL 60643-6969
United States

Phone: 773-445-1009 | Fax: 773-445-6939
View Map External Link
Primary Practice Address 9524 S HALSTED ST
CHICAGO, IL 60628-1028
United States

Phone: 773-445-1009 | Fax: 773-445-6939
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice IL 19014472