Organization
LITTLE P.C.
Active
Other names
East Lake Dental Home
Organization subpart
No
Provider details
NPI number
Authorized official
MONIQUE TUCKER (DIRECTOR OF INSURANCE)
(843) 990-9998
Entity
Organization
Contact information
Practice address
2100 ROSWELL RD STE 1108, MARIETTA, GA 30062-0883
(678) 401-5089
(864) 670-5285
Mailing address
4921 CENTRE POINTE DR STE 201, NORTH CHARLESTON, SC 29418-6997
(843) 990-9998
(864) 670-5285
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/11/2017
Last updated
12/08/2017
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