Provider Demographics
NPI:1497910327
Name:LITTLE, JEDEDIAH JON (DDS)
Entity Type:Individual
Prefix:
First Name:JEDEDIAH
Middle Name:JON
Last Name:LITTLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JED
Other - Middle Name:J
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:11295 STONECREEK DR
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-9138
Mailing Address - Country:US
Mailing Address - Phone:614-864-3196
Mailing Address - Fax:614-864-3192
Practice Address - Street 1:11295 STONECREEK DR
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9138
Practice Address - Country:US
Practice Address - Phone:614-864-3196
Practice Address - Fax:614-864-3192
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-022828122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist