1265521553 NPI number — DR. WALTER K LITTLE JR. DENTIST

Table of content: DR. WALTER K LITTLE JR. DENTIST (NPI 1265521553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265521553 NPI number — DR. WALTER K LITTLE JR. DENTIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LITTLE
Provider First Name:
WALTER
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
DENTIST
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265521553
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
712 S WASHINGTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36603-1302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-438-5747
Provider Business Mailing Address Fax Number:
251-438-5737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
712 S WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36603-1302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-438-5747
Provider Business Practice Location Address Fax Number:
251-438-5737
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  4581 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com