Provider Demographics
NPI:1477660934
Name:LITTLE, JEFFERY LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:LEE
Last Name:LITTLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 PLACEVILLE DRIVE
Mailing Address - Street 2:SUITE #19
Mailing Address - City:PLACEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667
Mailing Address - Country:US
Mailing Address - Phone:530-626-9127
Mailing Address - Fax:530-626-9418
Practice Address - Street 1:344 PLACEVILLE DRIVE
Practice Address - Street 2:SUITE #19
Practice Address - City:PLACEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667
Practice Address - Country:US
Practice Address - Phone:530-626-9127
Practice Address - Fax:530-626-9418
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA466391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice