Provider Demographics
NPI:1740375674
Name:GAILEY, NOELLE RENE (DDS)
Entity type:Individual
Prefix:DR
First Name:NOELLE
Middle Name:RENE
Last Name:GAILEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36150 DEQUINDRE RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-7149
Mailing Address - Country:US
Mailing Address - Phone:586-977-9050
Mailing Address - Fax:586-977-5706
Practice Address - Street 1:7650 DIXIE HWY STE 120
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346
Practice Address - Country:US
Practice Address - Phone:248-625-1769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010169671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice