Provider Demographics
NPI:1487035366
Name:LILES, ANTOINETTE (DMD)
Entity Type:Individual
Prefix:MISS
First Name:ANTOINETTE
Middle Name:
Last Name:LILES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 RIVERWIND DR STE 201
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-3387
Mailing Address - Country:US
Mailing Address - Phone:601-882-5600
Mailing Address - Fax:
Practice Address - Street 1:190 RIVERWIND DR STE 201
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-3387
Practice Address - Country:US
Practice Address - Phone:601-882-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3807-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice