Organization
DENTALWISE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDALL LITTLE (OWNER)
(770) 853-9244
Entity
Organization
Contact information
Practice address
2635 LEE RD STE C4, LITHIA SPRINGS, GA 30122-3356
(770) 489-9141
(770) 489-9138
Mailing address
2635 LEE RD STE C4, LITHIA SPRINGS, GA 30122-3356
(770) 489-9141
(770) 489-9138
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003141558A
—
GA
Enumeration date
04/08/2014
Last updated
04/08/2014
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