Healthcare Provider Details

I. General information

NPI: 1255275350
Provider Name (Legal Business Name): GUST ORTHODONTICS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 E 1ST ST
MCPHERSON KS
67460-3601
US

IV. Provider business mailing address

1325 E 1ST ST
MCPHERSON KS
67460-3601
US

V. Phone/Fax

Practice location:
  • Phone: 620-245-0411
  • Fax:
Mailing address:
  • Phone: 620-245-0411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CASSANDRA WIETH
Title or Position: DIRECTOR OF PAYOR RELATIONS
Credential:
Phone: 620-245-0411