Provider Demographics
NPI:1467621607
Name:LITTLE, THOMAS D (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:D
Last Name:LITTLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 1ST AVE E
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4561
Mailing Address - Country:US
Mailing Address - Phone:406-752-2180
Mailing Address - Fax:406-752-5276
Practice Address - Street 1:210 1ST AVE E
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4561
Practice Address - Country:US
Practice Address - Phone:406-752-2180
Practice Address - Fax:406-752-5276
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2096122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist