Bradford Bowen Liles, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5762 Issued in AL

Practice address

5721 Highway 90 Ste a
Theodore, AL 36582-3601

Phone

(251) 653-1300

Fax

(251) 653-1300

NPI assigned

Jun 8, 2010

Last updated

Aug 25, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Auburn Cosmetic and Implant Dentistry LLC

  • General Practice Dentistry
  • Auburn, AL
  • NPI 1528881463
  NPD Authorized official
• Liles Family Dentistry, LLC

  • Dental Clinic/Center
  • Auburn, AL
  • NPI 1689295339
  NPD Authorized official
• North Auburn Dentistry LLC

  • General Practice Dentistry
  • Auburn, AL
  • NPI 1033076898
  NPD Authorized official
• Bradford B. Liles, DMD, PC

  • General Practice Dentistry
  • Theodore, AL
  • NPI 1649670936
  NPD (past) Authorized official
• Lee Redditt DMD, PLLC

  • Dental Clinic/Center
  • Theodore, AL
  • NPI 1164096749
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1275955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408924800000",
    "number": "1447570825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5721 HIGHWAY 90 STE A",
            "city": "THEODORE",
            "state": "AL",
            "postal_code": "365823601",
            "telephone_number": "251-653-1300",
            "fax_number": "251-653-1300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5721 HIGHWAY 90 STE A",
            "city": "THEODORE",
            "state": "AL",
            "postal_code": "365823601",
            "telephone_number": "251-653-1300",
            "fax_number": "251-653-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LILES",
        "first_name": "BRADFORD",
        "middle_name": "BOWEN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-08",
        "last_updated": "2014-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "5762",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Jackson, PHARMD
• Megan Karst Jackson, DMD
• Frances Nichole Kittrell, RN
• Mackenzie Lander, NP
• Lee Redditt DMD, PLLC
• Kathleen Marlowe
• Courtney Marie McKain
• Melonie's Respitecare& Day Habilitation Inc.
• Mobilcare Medical, Inc.
• New Beginnings Womens Substance Abuse Treatment, Inc.

• General Practice Dentistry in Theodore, AL
• Providers in Theodore, AL by specialty
• General Practice Dentistry in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.