Provider Demographics
NPI:1811386923
Name:LITTLE, ANJA
Entity Type:Individual
Prefix:
First Name:ANJA
Middle Name:
Last Name:LITTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7058 CORPORATE WAY STE 3
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4243
Mailing Address - Country:US
Mailing Address - Phone:937-586-7729
Mailing Address - Fax:937-660-4450
Practice Address - Street 1:7058 CORPORATE WAY STE 3
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4243
Practice Address - Country:US
Practice Address - Phone:937-586-7729
Practice Address - Fax:937-660-4450
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH212011126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant