Provider Demographics
NPI:1083853287
Name:SUSAN E. LITTEKEN, D.D.S., P.C.
Entity Type:Organization
Organization Name:SUSAN E. LITTEKEN, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LITTEKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-724-0220
Mailing Address - Street 1:928 FIRST CAPITOL DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST. CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2734
Mailing Address - Country:US
Mailing Address - Phone:636-724-0220
Mailing Address - Fax:
Practice Address - Street 1:928 FIRST CAPITOL DRIVE
Practice Address - Street 2:
Practice Address - City:ST. CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2734
Practice Address - Country:US
Practice Address - Phone:636-724-0220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODEN 0152341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty