Provider Demographics
NPI:1366502833
Name:ROY A LITTLE III DMD PA
Entity Type:Organization
Organization Name:ROY A LITTLE III DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:ARMSTRONG
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-332-1331
Mailing Address - Street 1:214 WEST HOME AVENUE
Mailing Address - Street 2:
Mailing Address - City:HARTVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550
Mailing Address - Country:US
Mailing Address - Phone:843-332-1331
Mailing Address - Fax:843-857-9359
Practice Address - Street 1:214 WEST HOME AVENUE
Practice Address - Street 2:
Practice Address - City:HARTVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550
Practice Address - Country:US
Practice Address - Phone:843-332-1331
Practice Address - Fax:843-857-9359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC33301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9774Medicaid