FREDERICK GUSTAVE, D.D.S., PC (NPI# 1477720985) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477720985 |
| Entity Type | Organization |
| Organization Name | FREDERICK GUSTAVE, D.D.S., PC |
| Practice Address |
1111 E Walnut St Suite B Carbondale IL 62901-5000 |
| Practice Telephone | 6185292571 |
| Practice Fax Number | 6185292572 |
| Mailing Telephone | 6185292571 |
| Mailing Fax Number | 6185292572 |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2008-05-14 |
| Authorized Official Name | DR. FREDERICK GUSTAVE (OWNER/ORAL SURGEON) |
| Authorized Official Telephone | 6185292571 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QS0112X |
Clinic/Center Specialization: Oral and Maxillofacial Surgery |
019016600 | IL | Ambulatory Health Care Facilities |
| Street Address |
1111 E WALNUT ST SUITE B |
| City | CARBONDALE |
| State | IL |
| Zip Code | 62901-5000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891709168 | Frederick Gustave | Dentist | 1111 E Walnut St, Suite B, Carbondale, IL 62901-5006 | 2006-07-29 |
| 1932654852 | Harpreet Kaur | Dentist | 1111 E Walnut St, Carbondale, IL 62901-5000 | 2016-08-20 |
| 1417060674 | Michael Robert Durr | Dentist | 1111 E Walnut St, Carbondale, IL 62901-5006 | 2006-08-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558961268 | Gerad Aaron Harsy | Pharmacist | Walmart Pharmcy, 1450 East Main St, Carbondale, IL 62901 | 2020-10-30 |
| 1437708674 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak Street, Carbondale, IL 62901 | 2019-09-10 |
| 1306317383 | Rachael O Johnson | Nurse Practitioner | 404 S. Lewis Ln, Carbondale, IL 62901 | 2018-12-17 |
| 1740795194 | Megan Marie Zimmerman | Nurse Practitioner | 1100 W Diann Ln., Carbondale, IL 62901 | 2017-12-07 |
| 1295244242 | Amy Elizabeth Prudencio | Social Worker | 1301 E. Walnut Street, Carbondale, IL 62901 | 2017-09-21 |
| 1740708171 | Theresa Aleise Goodin | Speech-Language Pathologist | 1301 East Walnut Street, Carbondale, IL 62901 | 2017-09-06 |
| 1144762527 | Kathleen Chwalisz Rigney | Psychologist | 306 West Mill Street, Neurorestorative, Carbondale, IL 62901 | 2016-11-16 |
| 1285185173 | Shawnee Health Service and Development Corp | Social Worker | 404 S. Lewis Lane, Carbondale, IL 62901 | 2016-10-17 |
| 1437605094 | Arielle Greer | Nurse's Aide | 510 E. Russell St., A, Carbondale, IL 62901 | 2016-09-01 |
| 1518413863 | Complete Family Eyecare of Carbondale, PC | Optometrist | 1241 East Walnut Street, Carbondale, IL 62901 | 2016-08-28 |
| Find all providers in zip 62901 | ||||
| Taxonomy Code | 261QS0112X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538394556 | Shawnee Hills Oral & Maxillofacial Surgery, Sc | Clinic/Center | 2250 N Reed Station Rd, Suite 201, Carbondale, IL 62901-8101 | 2009-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427605351 | The Bloom Oral Surgery, P.C. | Clinic/Center | 219 N Hammes Ave Ste 1, Joliet, IL 60435-8145 | 2019-08-26 |
| 1528543121 | Joms LLC | Clinic/Center | 10 Martin Ave Ste 164, Naperville, IL 60540-6563 | 2018-09-28 |
| 1750861209 | Winterset Dental Care PC | Clinic/Center | 8559 S Pulaski Rd Ste 103, Chicago, IL 60652-3643 | 2018-08-15 |
| 1679070189 | Lakeside Oral & Implant Surgery Institute, PC | Clinic/Center | 5758 S Maryland Ave # 4h, Chicago, IL 60637-1426 | 2018-04-11 |
| 1962753210 | Millennium Surgical, Inc | Clinic/Center | 5978 S Archer Ave, Chicago, IL 60638-2817 | 2012-09-26 |
| 1851551642 | Alan Andreas Harvey | Clinic/Center | 2500 Ridge Ave Ste 302, Evanston, IL 60201-2477 | 2008-06-15 |
| 1881808053 | Oral and Maxillofacial Surgery Specalists Ltd. | Clinic/Center | 4035 Morsay Dr., Rockford, IL 61107-4871 | 2007-05-09 |
| 1962599605 | Affiliated Oral & Maxillofacial Surgeons Ltd | Clinic/Center | 3438 N Old Arlington Heights Rd, Arlington Heights, IL 60004 | 2006-10-06 |
| 1437703113 | Shady Oak Dental LLC Oral and Maxillofacial Surgeons of Northwest Il | Clinic/Center | 208 N Walnut Ave, Forreston, IL 61030-9330 | 2019-07-30 |
| 1598250995 | Periodontics and Implant Dentistry LLC | Clinic/Center | 8559 S Pulaski Rd, Chicago, IL 60652-3643 | 2018-06-27 |
| Find all providers with the same taxonomy | ||||
| City | CARBONDALE |
| Zip Code | 62901 |
Please comment or provide details below to improve the information on FREDERICK GUSTAVE, D.D.S., PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.