Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 30-2738 | SC |
NPI | 1013967363 |
---|---|
Provider Name | Dr. Craig Newelle Little |
First Address | Summerville, SC 29483-6547 |
Second Address | Summerville, SC 29483-6547 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ZA9743 | (05) | SC |