Healthcare Provider Details

I. General information

NPI: 1093266181
Provider Name (Legal Business Name): CLAIRE LITTLE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CENTER DR
GAINESVILLE FL
32610-3006
US

IV. Provider business mailing address

1395 CENTER DR
GAINESVILLE FL
32610-3006
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-7846
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN22055
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: