Provider Demographics
NPI:1497891618
Name:PELUSO, GUSTAVE JOSEPH III (DMD)
Entity type:Individual
Prefix:DR
First Name:GUSTAVE
Middle Name:JOSEPH
Last Name:PELUSO
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:2730 MANOR BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-2836
Mailing Address - Country:US
Mailing Address - Phone:404-405-7756
Mailing Address - Fax:404-795-1085
Practice Address - Street 1:980 SANDERS RD STE 200
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-5977
Practice Address - Country:US
Practice Address - Phone:770-205-3111
Practice Address - Fax:770-205-3311
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2010-11-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GADN0118821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice