Healthcare Provider Details

I. General information

NPI: 1821114497
Provider Name (Legal Business Name): AMANDA LITTLEFIELD DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 N GREEN MOUNT RD SUITE A
O FALLON IL
62269-3416
US

IV. Provider business mailing address

1490 N GREEN MOUNT RD SUITE A
O FALLON IL
62269-3416
US

V. Phone/Fax

Practice location:
  • Phone: 618-622-9720
  • Fax: 618-622-1700
Mailing address:
  • Phone: 618-622-9720
  • Fax: 618-622-1700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: