Provider Demographics
NPI:1417017559
Name:LILES, A.C. III (DDS)
Entity Type:Individual
Prefix:DR
First Name:A.C.
Middle Name:
Last Name:LILES
Suffix:III
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 1:1401 W ESPLANADE AVE
Mailing Address - Street 2:STE 816
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2845
Mailing Address - Country:US
Mailing Address - Phone:504-467-4555
Mailing Address - Fax:504-467-4586
Practice Address - Street 1:1401 W ESPLANADE AVE
Practice Address - Street 2:STE 816
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2845
Practice Address - Country:US
Practice Address - Phone:504-467-4555
Practice Address - Fax:504-467-4586
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA46341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice