Provider Demographics
NPI:1023237385
Name:NILES, ROBERT LIVINGSTON (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LIVINGSTON
Last Name:NILES
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 1:1145 KILDAIRE FARM RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4594
Mailing Address - Country:US
Mailing Address - Phone:919-469-9613
Mailing Address - Fax:
Practice Address - Street 1:1145 KILDAIRE FARM RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4594
Practice Address - Country:US
Practice Address - Phone:919-469-9613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4521122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8996452Medicaid