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General NPI Number Information
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NPI Number | 1366502833
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Entity Type | Organization
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Legal Business Name | ROY A LITTLE III DMD PA
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 214 WEST HOME AVENUE
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City | HARTVILLE
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State | SC
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Zip | 29550
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Country | US
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Telephone | 843-332-1331
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Fax | 843-857-9359
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Provider Business Mailing Address
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Address Line | 214 WEST HOME AVENUE
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City | HARTVILLE
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State | SC
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Zip | 29550
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Country | US
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Telephone | 843-332-1331
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Fax | 843-857-9359
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Authorized Official
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Title or Position | OWNER
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Name | ROY ARMSTRONG LITTLE III
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Credential | DMD
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Telephone | 843-332-1331
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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 | 3330
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License Number State | SC
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