Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DN22055 | FL |
NPI | 1093266181 |
---|---|
Provider Name | Claire Little |
First Address | Gainesville, FL 32610-3006 |
Second Address | Gainesville, FL 32610-3006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2016 |
Last Update Date | 02/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1275084204 | (05) | FL |