Provider Demographics
NPI:1750576757
Name:LITTLE-MUNDLE, BERNICE CASSANDRA (DDS)
Entity type:Individual
Prefix:
First Name:BERNICE
Middle Name:CASSANDRA
Last Name:LITTLE-MUNDLE
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 1:415 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3111
Mailing Address - Country:US
Mailing Address - Phone:719-562-4461
Mailing Address - Fax:
Practice Address - Street 1:1839 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-4748
Practice Address - Country:US
Practice Address - Phone:518-464-0402
Practice Address - Fax:518-464-0409
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053237-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice