Provider Demographics
NPI:1043597248
Name:ANDREA L. LITTLE, DMD, PSC
Entity Type:Organization
Organization Name:ANDREA L. LITTLE, DMD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-672-8800
Mailing Address - Street 1:PO BOX 1910
Mailing Address - Street 2:
Mailing Address - City:HYDEN
Mailing Address - State:KY
Mailing Address - Zip Code:41749-1910
Mailing Address - Country:US
Mailing Address - Phone:606-672-8800
Mailing Address - Fax:606-672-7549
Practice Address - Street 1:120 HIGHWAY 80
Practice Address - Street 2:
Practice Address - City:HYDEN
Practice Address - State:KY
Practice Address - Zip Code:41749-1910
Practice Address - Country:US
Practice Address - Phone:606-672-8800
Practice Address - Fax:606-672-7549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY69091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60069093Medicaid
KY45609724OtherEPSDT