Healthcare Provider Details

I. General information

NPI: 1356918031
Provider Name (Legal Business Name): KEYANI LITTLESUNDAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N BEAVER ST BLDG 2
FLAGSTAFF AZ
86001-3145
US

IV. Provider business mailing address

710 N BEAVER ST BLDG 2
FLAGSTAFF AZ
86001-3145
US

V. Phone/Fax

Practice location:
  • Phone: 928-773-8517
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH010703
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: