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General NPI Number Information
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NPI Number | 1487035366
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Entity Type | Individual
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Provider Name | ANTOINETTE LILES DMD
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Gender | Female
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Dates
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Enumeration Date | 06/16/2015
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 190 RIVERWIND DR STE 201
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City | PEARL
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State | MS
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Zip | 39208-3387
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Country | US
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Telephone | 601-882-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 551 N FEDERAL HWY STE 900
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-2559
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Country | US
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Telephone | 954-358-2722
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3807-15
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN29815
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License Number State | FL
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