Provider Demographics
NPI:1669048443
Name:LITTLER, MACY RENEE (DDS)
Entity type:Individual
Prefix:DR
First Name:MACY
Middle Name:RENEE
Last Name:LITTLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12710 W IH 10 STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1002
Mailing Address - Country:US
Mailing Address - Phone:903-280-5652
Mailing Address - Fax:
Practice Address - Street 1:12710 W INTERSTATE 10 STE 120
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1002
Practice Address - Country:US
Practice Address - Phone:210-836-9920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39279122300000X
AR4516122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist