MEDICARE: ANJA LITTLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	126800000X	Dental Assistant	212011	OH

General Provider Information

NPI Number	:	1811386923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANJA LITTLE

Provider Business Mailing Address
First Line	:	7058 CORPORATE WAY STE 3
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-4243
Country	:	US
Telephone Number	:	937-586-7729
Fax Number	:	937-660-4450

Provider Business Practice Location Address
First Line	:	7058 CORPORATE WAY STE 3
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-4243
Country	:	US
Telephone Number	:	937-586-7729
Fax Number	:	937-660-4450

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2015
Last Update Date	:	01/13/2015

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Directions to “ ANJA LITTLE ” Practice Location

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