Organization
BRADFORD B. LILES, DMD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADFORD BOWEN LILES DMD (OWNER/DENTIST)
(251) 653-1300
Entity
Organization
Contact information
Practice address
5721 HIGHWAY 90 STE A, THEODORE, AL 36582-3601
(251) 653-1300
(251) 653-1242
Mailing address
5721 HIGHWAY 90 STE A, THEODORE, AL 36582-3601
(251) 653-1300
(251) 653-1242
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5762
AL
Other
Enumeration date
08/25/2014
Last updated
08/25/2014
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