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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
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice IL 19014472
Other Identifiers
Issuer State Number
Endpoint Information
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location