Healthcare Provider Details

I. General information

NPI: 1700277431
Provider Name (Legal Business Name): ANGELA LITTLE RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 TRIANGLE PARK DR SUITE 3
CONCORD NH
03301-5790
US

IV. Provider business mailing address

255 SWAMP RD
EPSOM NH
03234-4714
US

V. Phone/Fax

Practice location:
  • Phone: 603-225-6331
  • Fax:
Mailing address:
  • Phone: 603-848-3591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number02492
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: