Provider Demographics
NPI:1386969822
Name:BRILEY, GAYLE C (RDH)
Entity type:Individual
Prefix:
First Name:GAYLE
Middle Name:C
Last Name:BRILEY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26208 S BELL RD
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-3369
Mailing Address - Country:US
Mailing Address - Phone:815-521-1499
Mailing Address - Fax:
Practice Address - Street 1:26208 S BELL RD
Practice Address - Street 2:
Practice Address - City:CHANNAHON
Practice Address - State:IL
Practice Address - Zip Code:60410-3369
Practice Address - Country:US
Practice Address - Phone:815-521-1499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-27
Last Update Date:2010-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020.012838124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist