Provider Demographics
NPI:1649907312
Name:LITTLE BEAR PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:LITTLE BEAR PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NUTHYLA
Authorized Official - Middle Name:SINADA
Authorized Official - Last Name:SKUJA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:484-238-0348
Mailing Address - Street 1:650 CARNEGIE BLVD
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-8519
Mailing Address - Country:US
Mailing Address - Phone:484-238-0348
Mailing Address - Fax:
Practice Address - Street 1:650 CARNEGIE BLVD
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-8519
Practice Address - Country:US
Practice Address - Phone:484-238-0348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty