Provider Demographics
NPI:1700961984
Name:LITTLE, LORI JANE (RDA)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:JANE
Last Name:LITTLE
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 UNION PL APT B27
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-5905
Mailing Address - Country:US
Mailing Address - Phone:931-374-8399
Mailing Address - Fax:
Practice Address - Street 1:5073 COLUMBIA PIKE
Practice Address - Street 2:SUITE 240
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-8607
Practice Address - Country:US
Practice Address - Phone:615-302-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000007370126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant