Provider Demographics
NPI:1689295339
Name:LILES FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:LILES FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:LILES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-539-5570
Mailing Address - Street 1:1523 MARIE LOOP
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-6720
Mailing Address - Country:US
Mailing Address - Phone:251-422-6833
Mailing Address - Fax:
Practice Address - Street 1:2234 OGLETREE VILLAGE LN
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-2967
Practice Address - Country:US
Practice Address - Phone:334-539-5570
Practice Address - Fax:334-539-5567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental