Provider Demographics
NPI:1033473103
Name:LITTLEGRINS , P.L.L.C
Entity Type:Organization
Organization Name:LITTLEGRINS , P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:DREW
Authorized Official - Last Name:GALLEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-782-4708
Mailing Address - Street 1:2179 W 24TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6163
Mailing Address - Country:US
Mailing Address - Phone:928-782-4708
Mailing Address - Fax:928-782-2212
Practice Address - Street 1:2179 W 24TH ST STE B
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6163
Practice Address - Country:US
Practice Address - Phone:928-782-4708
Practice Address - Fax:928-782-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43901223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ155269002Medicaid