Provider Demographics
NPI:1639399884
Name:E. G. LITTKE D.D.S., MSF, P.C.
Entity Type:Organization
Organization Name:E. G. LITTKE D.D.S., MSF, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:LITTKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:781-749-4040
Mailing Address - Street 1:185 LINCOLN STREET SUITE B1
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043
Mailing Address - Country:US
Mailing Address - Phone:781-749-4040
Mailing Address - Fax:
Practice Address - Street 1:185 LINCOLN STREET SUITE B1
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043
Practice Address - Country:US
Practice Address - Phone:781-749-4040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA143491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX11138OtherBCBS PROVIDER