Provider Demographics
NPI:1689792640
Name:LITTLEJOHN, ROBERT LANEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LANEY
Last Name:LITTLEJOHN
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 1:111 PROFESSIONAL PL
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-2756
Mailing Address - Country:US
Mailing Address - Phone:662-453-5217
Mailing Address - Fax:662-455-2498
Practice Address - Street 1:111 PROFESSIONAL PL
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-2756
Practice Address - Country:US
Practice Address - Phone:662-453-5217
Practice Address - Fax:662-455-2498
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3272031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06651367Medicaid