Provider Demographics
NPI:1881269777
Name:LITTLE, LAUREN TAYLOR (DMD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:TAYLOR
Last Name:LITTLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 COMBS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-9769
Mailing Address - Country:US
Mailing Address - Phone:606-275-1339
Mailing Address - Fax:
Practice Address - Street 1:1508 OXFORD DR STE 2
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9266
Practice Address - Country:US
Practice Address - Phone:027-350-2195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10590390200000X, 1223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY10590OtherKENTUCKY BOARD OF DENTISTRY LICENSE