NPIMap

Organization Active NPI

Bradford B. Liles, DMD, PC

  • General Practice Dentistry
  • Theodore, AL
National Provider Identifier
1649670936
Registry record updated Aug 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5762 Issued in AL
Legal business name
BRADFORD B. LILES, DMD, PC
Practice address
5721 Highway 90 Ste a
Theodore, AL 36582-3601
Phone
(251) 653-1300
Fax
(251) 653-1242
NPI assigned
Aug 25, 2014
Last updated
Aug 25, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2014

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

Authorized official

Name
Bradford Bowen Liles, DMDNPI 1447570825
Title
Owner/Dentist
Phone
(251) 653-1300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 5762 AL Primary

Addresses

Primary practice location

5721 Highway 90 Ste a
Theodore, AL 36582-3601

Mailing address

5721 Highway 90 Ste a
Theodore, AL 36582-3601
Phone (251) 653-1300

National Provider Directory

National Provider Directory

Locations

5721 Highway 90
Ste A
Theodore, AL 36582
Phone (251) 653-1242

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1408924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408924800000",
    "number": "1649670936",
    "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": "251-653-1242"
        },
        {
            "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": "251-653-1242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRADFORD B. LILES, DMD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-25",
        "last_updated": "2014-08-25",
        "status": "A",
        "authorized_official_last_name": "LILES",
        "authorized_official_first_name": "BRADFORD",
        "authorized_official_middle_name": "BOWEN",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "251-653-1300",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "5762",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Theodore, AL

Sources for this page

  • 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.