NPIMap

Organization Active NPI

Frederick Gustave, D.D.S., PC

  • Oral and Maxillofacial Surgery Clinic/Center
  • Carbondale, IL
National Provider Identifier
1477720985
Registry record updated May 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X
License
019016600 Issued in IL
Legal business name
FREDERICK GUSTAVE, D.D.S., PC
Practice address
1111 E Walnut St
Suite B
Carbondale, IL 62901-5000
Phone
(618) 529-2571
Fax
(618) 529-2572
NPI assigned
May 14, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Frederick Gustave, DDS
Title
Owner/Oral Surgeon
Phone
(618) 529-2571

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery Clinic/Center 261QS0112X 019016600 IL Primary

Addresses

Primary practice location

1111 E Walnut St
Suite B
Carbondale, IL 62901-5000

Mailing address

1111 E Walnut St
Suite B
Carbondale, IL 62901-5000
Phone (618) 529-2571

National Provider Directory

National Provider Directory

Locations

1111 E Walnut St
#B
Carbondale, IL 62901
Phone (618) 529-2571

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210723200000",
    "number": "1477720985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 E WALNUT ST",
            "address_2": "SUITE B",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629015000",
            "telephone_number": "618-529-2571",
            "fax_number": "618-529-2572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 E WALNUT ST",
            "address_2": "SUITE B",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629015000",
            "telephone_number": "618-529-2571",
            "fax_number": "618-529-2572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDERICK GUSTAVE, D.D.S., PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-14",
        "last_updated": "2008-05-14",
        "status": "A",
        "authorized_official_last_name": "GUSTAVE",
        "authorized_official_first_name": "FREDERICK",
        "authorized_official_title_or_position": "OWNER/ORAL SURGEON",
        "authorized_official_telephone_number": "618-529-2571",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "019016600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carbondale, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.