Provider Demographics
NPI:1588028856
Name:LITTLE SMILES
Entity Type:Organization
Organization Name:LITTLE SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-435-4694
Mailing Address - Street 1:8629 HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71295-5426
Mailing Address - Country:US
Mailing Address - Phone:318-435-4694
Mailing Address - Fax:318-435-5503
Practice Address - Street 1:610 PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-2628
Practice Address - Country:US
Practice Address - Phone:318-435-4694
Practice Address - Fax:318-435-5503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4085122300000X
LA6059122300000X
LA4623124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1860590Medicaid
LA1840858Medicaid