Provider Demographics
NPI:1447486501
Name:BESLEY, GARY ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALAN
Last Name:BESLEY
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 1:1450 S. WEST AVE.
Mailing Address - Street 2:1215 HILLCREST DR
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032
Mailing Address - Country:US
Mailing Address - Phone:815-235-9817
Mailing Address - Fax:815-235-9821
Practice Address - Street 1:1450 S. WEST AVE.
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032
Practice Address - Country:US
Practice Address - Phone:815-235-9817
Practice Address - Fax:815-235-9821
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0147971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice