Healthcare Provider Details

I. General information

NPI: 1689894834
Provider Name (Legal Business Name): KEVIN LITTLEFIELD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E JACKSON
MORTON IL
61550
US

IV. Provider business mailing address

320 E JACKSON
MORTON IL
61550
US

V. Phone/Fax

Practice location:
  • Phone: 309-266-6705
  • Fax: 309-266-1242
Mailing address:
  • Phone: 309-266-6705
  • Fax: 309-266-1242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name: KEVIN LITTLEFIELD
Title or Position: PRESIDENT
Credential: DMD LTD
Phone: 309-266-6705