Healthcare Provider Details

I. General information

NPI: 1558371187
Provider Name (Legal Business Name): CHESTER BERNARD GAUSS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 W SAINT CLAIR ST
MARINE CITY MI
48039-3544
US

IV. Provider business mailing address

998 HIGHLAND DR
SAINT CLAIR MI
48079-4294
US

V. Phone/Fax

Practice location:
  • Phone: 810-765-9200
  • Fax: 810-765-6460
Mailing address:
  • Phone: 810-326-0225
  • Fax: 810-765-6460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901015321
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: