Provider Demographics
NPI:1437910056
Name:LITTLE, MELISSA (RDH)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:LITTLE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6644 W SKY BIRD CIR
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-1736
Mailing Address - Country:US
Mailing Address - Phone:801-389-1253
Mailing Address - Fax:
Practice Address - Street 1:14003 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:BLUFFDALE
Practice Address - State:UT
Practice Address - Zip Code:84065-5260
Practice Address - Country:US
Practice Address - Phone:801-254-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13771021-9920124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist