Provider Demographics
NPI:1962623769
Name:GUTSELL, GERALD G (DDS)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:G
Last Name:GUTSELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 W HIGGINS AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-2009
Mailing Address - Country:US
Mailing Address - Phone:773-763-0433
Mailing Address - Fax:
Practice Address - Street 1:6801 W HIGGINS AVE
Practice Address - Street 2:SUITE E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-2009
Practice Address - Country:US
Practice Address - Phone:773-763-0433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice