Provider Demographics
NPI:1679663041
Name:ILES, CARRIE M (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:M
Last Name:ILES
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 1:184 SEARGENT PRENTISS DR.
Mailing Address - Street 2:184 SEARGENT PRENTISS DR
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120
Mailing Address - Country:US
Mailing Address - Phone:601-442-0452
Mailing Address - Fax:
Practice Address - Street 1:184 SGT. PRENTISS DR.
Practice Address - Street 2:184 SGT. PRENTISS DR
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120
Practice Address - Country:US
Practice Address - Phone:601-442-0452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2734-931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice