Healthcare Provider Details

I. General information

NPI: 1447252481
Provider Name (Legal Business Name): RIDGE MORGAN GILLEY D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11TH DENTAL SQUADRON 238 BROOKLEY AVE
BOLLING AFB DC
20032
US

IV. Provider business mailing address

14800 PALE MORNING PL
HUGHESVILLE MD
20637-2418
US

V. Phone/Fax

Practice location:
  • Phone: 202-404-6380
  • Fax: 202-767-4091
Mailing address:
  • Phone: 301-274-3963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number12850
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: