Healthcare Provider Details

I. General information

NPI: 1356526867
Provider Name (Legal Business Name): JARED REED LITTLE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 CUMING STREET OFFICE 335F
OMAHA NE
68178-6624
US

IV. Provider business mailing address

21518 PINEHURST AVE
ELKHORN NE
68022-2209
US

V. Phone/Fax

Practice location:
  • Phone: 402-280-5990
  • Fax: 402-280-5013
Mailing address:
  • Phone: 406-240-2124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2243
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7413
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: