Provider Demographics
NPI:1083885602
Name:LITTLE, THOMAS MICHAEL SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:LITTLE
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16019 HIGHWAY 105 W
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-5640
Mailing Address - Country:US
Mailing Address - Phone:936-588-8811
Mailing Address - Fax:936-588-8813
Practice Address - Street 1:16019 HIGHWAY 105 W
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-5640
Practice Address - Country:US
Practice Address - Phone:936-588-8811
Practice Address - Fax:936-588-8813
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-23
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice