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General NPI Number Information
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NPI Number | 1689295339
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Entity Type | Organization
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Legal Business Name | LILES FAMILY DENTISTRY, LLC
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Dates
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Enumeration Date | 05/05/2020
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Last Update Date | 05/05/2020
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Provider Practice Location Address
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Address Line | 2234 OGLETREE VILLAGE LN
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City | AUBURN
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State | AL
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Zip | 36830-2967
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Country | US
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Telephone | 334-539-5570
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Fax | 334-539-5567
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Provider Business Mailing Address
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Address Line | 1523 MARIE LOOP
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City | AUBURN
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State | AL
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Zip | 36830-6720
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Country | US
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Telephone | 251-422-6833
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. BRADFORD LILES
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Credential | DMD
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Telephone | 334-539-5570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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