Provider Demographics
NPI:1689894834
Name:KEVIN LITTLEFIELD
Entity Type:Organization
Organization Name:KEVIN LITTLEFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD LTD
Authorized Official - Phone:309-266-6705
Mailing Address - Street 1:320 E JACKSON
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550
Mailing Address - Country:US
Mailing Address - Phone:309-266-6705
Mailing Address - Fax:309-266-1242
Practice Address - Street 1:320 E JACKSON
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550
Practice Address - Country:US
Practice Address - Phone:309-266-6705
Practice Address - Fax:309-266-1242
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
IL122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty