Provider Demographics
NPI:1316994700
Name:LILES, EDMOND HAROLD (DDS)
Entity type:Individual
Prefix:
First Name:EDMOND
Middle Name:HAROLD
Last Name:LILES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 B ROBIN AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28512
Mailing Address - Country:US
Mailing Address - Phone:252-726-1277
Mailing Address - Fax:
Practice Address - Street 1:202 WB MCLEAN DR
Practice Address - Street 2:HARROLD & SHOLAR DDS PA
Practice Address - City:CAPE CARTERET
Practice Address - State:NC
Practice Address - Zip Code:28584
Practice Address - Country:US
Practice Address - Phone:252-393-8168
Practice Address - Fax:252-393-2978
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC42201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7995273Medicaid
95273OtherNC BLUE CROSS BLUE SHIELD
1346100OtherUNITED CONCORDIA