Provider Demographics
NPI:1447252481
Name:GILLEY, RIDGE MORGAN (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:RIDGE
Middle Name:MORGAN
Last Name:GILLEY
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14800 PALE MORNING PL
Mailing Address - Street 2:
Mailing Address - City:HUGHESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20637-2418
Mailing Address - Country:US
Mailing Address - Phone:301-274-3963
Mailing Address - Fax:
Practice Address - Street 1:11TH DENTAL SQUADRON
Practice Address - Street 2:238 BROOKLEY AVE
Practice Address - City:BOLLING AFB
Practice Address - State:DC
Practice Address - Zip Code:20032
Practice Address - Country:US
Practice Address - Phone:202-404-6380
Practice Address - Fax:202-767-4091
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD128501223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics