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General NPI Number Information
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NPI Number | 1083853287
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Entity Type | Organization
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Legal Business Name | SUSAN E. LITTEKEN, D.D.S., P.C.
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Dates
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Enumeration Date | 02/11/2009
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Last Update Date | 02/11/2009
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Provider Practice Location Address
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Address Line | 928 FIRST CAPITOL DRIVE
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City | ST. CHARLES
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State | MO
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Zip | 63301-2734
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Country | US
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Telephone | 636-724-0220
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Fax |
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Provider Business Mailing Address
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Address Line | 928 FIRST CAPITOL DRIVE
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City | ST. CHARLES
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State | MO
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Zip | 63301-2734
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Country | US
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Telephone | 636-724-0220
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUSAN E. LITTEKEN
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Credential | D.D.S.
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Telephone | 636-724-0220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN 015234
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License Number State | MO
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