1376359497 NPI number — DODSON AND LILES SMILES, LLC

Table of content: MATTHEW NALIBORSKI RD, LDN (NPI 1023392115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376359497 NPI number — DODSON AND LILES SMILES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DODSON AND LILES SMILES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376359497
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1204 OGLETREE VILLAGE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36830-2960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-887-0099
Provider Business Mailing Address Fax Number:
334-209-2067

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
428 MADISON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDER CITY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35010-2571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-444-1454
Provider Business Practice Location Address Fax Number:
334-209-2067
Provider Enumeration Date:
12/04/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LILES
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
BRABNER
Authorized Official Title or Position:
OWNER/DENTIST
Authorized Official Telephone Number:
334-887-0099

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)