MEDICARE: MS. LORI JANE LITTLE RDA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	126800000X	Dental Assistant	0000007370	TN

General Provider Information

NPI Number	:	1700961984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORI JANE LITTLE RDA

Provider Business Mailing Address
First Line	:	1955 UNION PL APT B27
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-5905
Country	:	US
Telephone Number	:	931-374-8399
Fax Number	:

Provider Business Practice Location Address
First Line	:	5073 COLUMBIA PIKE
Second Line	:	SUITE 240
City	:	SPRING HILL
State	:	TN
Zip	:	37174-8607
Country	:	US
Telephone Number	:	615-302-4200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/08/2007

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