MEDICARE: DR. RIDGE MORGAN GILLEY D.D.S., M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	12850	MD

General Provider Information

NPI Number	:	1447252481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RIDGE MORGAN GILLEY D.D.S., M.S.

Provider Business Mailing Address
First Line	:	14800 PALE MORNING PL
Second Line	:
City	:	HUGHESVILLE
State	:	MD
Zip	:	20637-2418
Country	:	US
Telephone Number	:	301-274-3963
Fax Number	:

Provider Business Practice Location Address
First Line	:	11TH DENTAL SQUADRON
Second Line	:	238 BROOKLEY AVE
City	:	BOLLING AFB
State	:	DC
Zip	:	20032
Country	:	US
Telephone Number	:	202-404-6380
Fax Number	:	202-767-4091

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/08/2007

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