# LITTLE EGYPT PEDIATRIC DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285377036
- **Authorized official:** TRAVIS CRIPPS (OWNER)
- **Authorized official phone:** (618) 694-2110

## Contact information

- **Practice address:** 1255 CEDAR CT, CARBONDALE, IL 62901-5335
- **Practice address phone:** (618) 319-4536
- **Mailing address:** 1255 CEDAR CT, CARBONDALE, IL 62901-5335

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | — | NULL | Yes |
| 1223P0221X | Pediatric Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 04/19/2022
- **Last updated:** 04/19/2022